Total quadriceps sparing, endoscopic single-incision anterior cruciate ligament reconstruction using fresh frozen allograft tissue: surgical technique and potential pitfalls.

Reconstruction is now the procedure of choice in symptomatic patients who are physically active following rupture of the anterior cruciate ligament (ACL). Previous reported treatment of ACL tears include: primary repair, repair with extra-articular augmentation, isolated extraarticular augmentation, intra-articular reconstruction through mini-arthrotomy, and arthroscopic-assisted intraarticular reconstruction. Graft material has varied and has included the iliotibial band, hamstring tendons, patellar ligament, allograft tissue, xenograft tissue, and prosthetic devices. The advent of arthroscopically-assisted reconstruction techniques has lessened tissue damage and enhanced early rehabilitation. In addition, the current trend towards early aggressive physical therapy, consisting of immediate motion, immediate weight bearing, and an early return to functional activities, has shortened the previously prolonged rehabilitation process14. Based on these considerations, ACL reconstructive surgery performed arthroscopically has become more attractive to both the surgeon and patient. Fresh frozen allografts have been used at the senior author's institution over the last six years. Our results compare favorably with published results using autograft tissue 2. Advantages of allograft tissue include less donor site morbidity, improved cosmesis, shortened operative time, and possibly a decreased incidence of stiff knee following reconstruction4. Potential disadvantages of using bone-patellar tendon-bone autograft tissue include harvest morbidity, donor site pain, quadriceps weakness, patellar tendon weakness/rupture, and patellar fracture. In selected cases of multiple ligament surgery and revision ligament surgery, allograft tissue is preferred over autograft. Our technique of using fresh frozen allograft tissue allows ACL reconstruction through two standard arthroscopic portals, and a single 3 centimeter (cm) tibial