Arthroscopically assisted ACL reconstruction using central third patellar tendon autograft with press fit femoral fixation.

The ACL is a complex structure, and its replacement involves precise surgical technique, which relates directly to its function in constraining anterior tibial translation. Many techniques have been developed for reconstruction of the ACL. Here we have described our method of choice for arthroscopically assisted graft placement, which uses the middle-third patellar tendon autograft placed using a press-fit fixation technique. This technique was developed to avoid drawbacks encountered with fixation using an interference screw. Biomechanical testing has shown this technique to be similar in pull-out strength to fixation obtained with an interference screw, but without the associated technical difficulties. One other benefit of this technique, which is not readily apparent, and not one that we, as surgeons, would ever hope to take advantage of, is that should a revision ACL reconstruction be necessary in the future, there is no interference screw in the femur to remove.