Anterior Cruciate Ligament Reconstruction: Flowchart of Technical Options and Relationship with the Instrument Sets


  • Francisco Guerra Pinto Hospital Ortopédico de Sant’Ana, Parede, Portugal Author
  • Rita Alçada Serviço de Ortopedia, Hospital de Cascais, Dr. José de Almeida, Cascais, Portugal Author
  • Jácome Pacheco Hospital Ortopédico de Sant’Ana, Parede, Portugal Author
  • Gonçalo Moraes Sarmento Hospital Ortopédico de Sant’Ana, Parede, Portugal Author
  • Carlos Martinho Serviço de Ortopedia, Hospital de Cascais, Dr. José de Almeida, Cascais, Portugal Author
  • António Martins Hospital Ortopédico de Sant’Ana, Parede, Portugal Author


Anterior Cruciate Ligament/surgery, Anterior Cruciate Ligament Injuries/surgery, Anterior Cruciate Ligament Reconstruction/methods


The anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopedic surgeries. Despite the extensive literature available, it is difficult to find a pragmatic description of the different technical variants that can guide multiple surgical decisions. In this review article, the technical variants of ACL reconstruction are systematically described, namely in the collection and preparation of the graft, in the creation of tunnels and in the fixation of the graft. The hypothesis of supplementing the reconstruction with an anterolateral reconstruction or tenodesis is described. This review includes a discussion on potential intraoperative difficulties and their respective solutions, such as graft contamination, sub‐optimal positioning of the tunnels and insufficient fixation of the graft. It is the opinion of the authors that the ACL reconstruction can become more complex due to the surgeon’s attempt to adapt his technique to the available commercial set. As so, we suggest a simplified surgical technique with an algorithm which is independent from the specificities of each set.


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Anterior Cruciate Ligament Reconstruction: Flowchart of Technical Options and Relationship with the Instrument Sets. (2024). Orthopaedic SPOT, 1(2), 58-72.

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