Advances in the three-portal technique for anatomical single- or double-bundle ACL reconstruction

Purpose: To describe the "three-portal technique for anatomical ACL single- or double-bundle reconstruction" and the arthroscopic viewing improvement provided by this technique. Methods: A "high" anterolateral portal was placed 1 cm lateral to the patellar tendon and the most inferior portion of the portal at the level of the inferior pole of the patella. A "central" portal was placed using a spinal needle under arthroscopic visualization following the orientation of the previous ACL fibers. An accessory medial portal was also placed using a spinal needle respecting a 2-mm distance to the medial femoral condyle. Results: The "high" anterolateral portal permitted a broad and unobstructed view of the ACL tibial attachment. The "central" portal allowed a straightforward view of the ACL femoral remnant and bony landmarks in the intercondylar notch. The accessory medial portal enabled to reach the femoral native insertion site of the ACL. Conclusion: The three-portal technique provides a proper view of the soft tissue remnants and bony landmarks facilitating an anatomical positioning of the graft.