Portals

Anatomic ACL reconstruction is the gold-standard treatment for ACL tears. It best restores knee biomechanics and function. The anatomy of the ACL femoral insertion site, including viable remnant and bony landmarks, should be well understood by the surgeon. The use of an anteromedial accessory portal in ACL reconstruction is a viable and versatile technique that should be part of the orthopedic surgeon’s arsenal. The use of different three portal combinations to anatomically reconstruct the ACL gives the surgeon a myriad of options to tailor the best treatment for each patient. The use of an accessory medial portal has better clinical and patient-reported outcomes when compared to the use of the transtibial technique, although studies have yet to demonstrate unequivocal clinical superiority. Good-quality randomized control trials are warranted in the future to prove if the differences encountered in current literature are clinically significant.