Table 1.

Pearls and Pitfalls

	Pearls	Pitfalls
Trans-septal approach	Posterolateral and posteromedial portals should be well established. Shaver faces toward the scope (anterior) in order to avoid any popliteal neurovascular bundle injury The PCL tibial attachment exposure can be completely achieved by detaching the posterior capsule from the PCL for more than 10 mm downward from the articular surface. In addition to a direct visualization, a fluoroscopic examination is recommended to confirm the location of the tip of the guidewire before overdrilling it with a reamer.	Creating the posterior portals using the light source to transilluminate the skin incision, which avoids neurovascular injury Gentle removal of the central-inferior septum is important to avoid iatrogenic injury to the middle genicular vessels. The retained PCL tibial attachment is useful for setting the orientation of the center of the PCL tibial attachment.
PCL/ PT tunnel creation	The PCL tibial attachment exposure can be completely achieved by detaching the posterior capsule from the PCL for more than 10 mm downward from the articular surface.	Carefully keep the cutting surface of the shaver in the anteroinferior direction, facing the bone and away from neurovascular bundle.
Graft fixation	The tension of the ACL provides relatively accurate information about the reduction of the knee joint.	While fixing the PCL graft, maintain the tibia reduced by pulling the proximal tibia anteriorly, while the knee is flexed at 90°.

ACL, anterior cruciate ligament; PCL, posterior cruciate ligament.