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C.H. BROWN
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There are many advantages of the 3 portal
technique compared to the traditional 2 portal
approach:
• The 3 portal technique allows the surgeon to
interchange the working and viewing portals
according to the specific task that is being
performed.
• In the 3 portal technique, the lateral wall of
the intercondylar notch can be viewed
orthogonally through the AM portal while the
AAM portal is used as a working portal for
instrumentation. This approach allows the
surgeon to look and work in the same
direction, making it easier to achieve more
consistent and accurate placement of the ACL
femoral tunnel within the native ACL femoral
attachment site (fig. 2).
• Viewing the lateral wall of the intercondylar
notch through the AM portal also eliminates
the need to perform a notchplasty for
visualization purposes.
• Drilling the ACL femoral tunnel through the
AAM portal increases the obliquity of the
ACL femoral tunnel relative to lateral wall of
the intercondylar notch resulting in a longer
femoral tunnel.
• The 3 portal technique is versatile and can be
used when performing an anatomic ACL
reconstruction with any type of ACL graft
and most ACL graft fixation methods.
• The 3 portal technique can be used for any
primary, revision, single
-
or doublebundle
ACL reconstruction.
• The technique is particularly useful in cases
where only one of the two ACL bundles is
torn or there is a large remnant of the native
ACL present. In these situations, an
augmentation or tissue preserving procedure
can be performed. Augmentation and tissue
preserving procedures cannot be performing
using a transtibial or an all
-
inside technique.
• Avoids a lateral incision.
• Requires minimal instrumentation (no need
for expensive retro drills).
DISADVANTAGES OF
DRILLING THE ACL
FEMORAL TUNNEL
THROUGH AMEDIAL
PORTAL
• Requires the knee to be positioned in
hyperflexion.
Fig. 2:
Using the AM portal as a viewing portal and
drilling the femoral tunnel through the AAM portal
allows you to see exactly what part of the ACL
femoral footprint your femoral tunnel will cover.