Fig 9.

Tibial tunnel preparation. (A) Perforation of new tibial tunnel. A tibial aiming guide (I) is inserted through the anteromedial portal (II) with its tip located at the optimal anchoring point (III). The arthroscope is used from the anterolateral portal. An incision is made over the scars of the previous surgical procedures (if possible), and the guidewire is advanced toward the joint. Once correct positioning has been confirmed, the tunnel is drilled over the wire up to the diameter of the reconstruction. Because our technique uses the graft bone block itself as tibial fixation, the first distal centimeters of the tunnel are drilled to a diameter similar to that of the bone block. (B) Intraoperative clinical image showing tibial aiming guide (I) introduced through anteromedial portal (II) in desired orientation. The introduction of the guidewire is performed from distal to proximal using the same incision (III) from the previous surgical procedures when possible.