**11. Conclusion**

214 Modern Arthroscopy

attachment. On the tibial side the tunnel is drilled in the center of the ACL foot print, slightly medial. As the femoral tunnel is much lower than with the transtibial technique, the resulting graft has a more oblique orientation and is able to resist anterior tibial translation

> A B

 A B Fig. 13. Femoral socket for single bundle anatomic reconstruction. A: the lateral wall of the intercondylar notch has been gently cleaned with a curette to locate the lateral intercondylar ridge (arrows). B: position of a 9mm socket, right behind the intercondylar ridge. C: the socket aperture is positioned in such a way that it overlaps 50% of the PLB- and 50% of the AMB attachment sites. A,B, and C views are taken from the medial side. D: view of the

Fig. 14. Comparison of the obliquity of an anatomic single bundle ACL (A) with a native ACL (B). Note the similarity in orientation of both reconstructed and native ACL.

A B

and tibial internal rotation (Fig. 14).

socket from the AL portal.

There is still much to learn about ACL reconstruction. The old transtibial technique which does not reconstruct the ACL where it is attached has progressively evolved toward anatomical ACL reconstruction. Currently anatomic single- and double-bundle ACL reconstruction are well established and well described. However, if the outcome of these techniques has considerably improved with regard to the transtibial technique, the results are still far to be perfect. There are still small percentages of fair results for which improvements have to be made. Only long term results will tell if the restoration of ACL anatomy is going to decrease knee joint degeneration which remains the major issue of long term outcome of ACL reconstruction
