Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement.

We describe our current technique of anatomic, double-bundle (DB), rectangular tunnel anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft. This technique mimics the natural, or anatomic, arrangement of the native ACL fibers. This technique has the following advantages: (1) creation of a DB ACL reconstruction with a single BPTB graft; (2) maximization of graft-tunnel contact area; (3) containment of the tunnel apertures within the anatomic ACL attachment footprint; (4) rotational control of the graft within the tunnels during and after fixation; and (5) preservation of notch anatomy.

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