Table 2.

Advantages and Disadvantages to the Transtibial and Anteromedial Techniques for Anterior Cruciate Ligament Reconstruction

Transtibial technique

Advantages

Isometric graft placement

Possibility of reaching native femoral insertion if tibial tunnel is made appropriately

Ease of graft passage

Familiarity and proven long-term outcomes

Disadvantages

Risk for non-anatomic graft placement

Femoral tunnel placement constrained by tibial tunnel

Tendency to create a vertical graft which can cause rotational instability and pivot shift if not appropriately positioned

Short oblique tibial tunnel in an attempt to achieve anatomic ACL reconstruction

Anteromedial technique

Disadvantages

Requires hyperflexion of the knee (requiring qualified assistants)

Can result in a short femoral tunnel

Can result in posterior wall blow-out due to tunnel angle