Minimally Invasive 2-Incision Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction Using Retrograde Reamer Guide to Prevent Graft-Construct Mismatch

Graft-tunnel mismatch (GTM) is a known technical challenge that can occur with anterior cruciate ligament reconstruction when using a patellar tendon autograft. Two-incision anterior cruciate ligament reconstruction is a well-established technique with excellent outcomes and can serve as an excellent tool to prevent GTM. Traditionally, 2-incision femoral tunnel drilling has been performed using an over-the-top guide through a lateral incision, but more modern retrograde reamer guides can allow this to be done percutaneously. We detail how a minimally invasive 2-incision femoral tunnel drilling technique can be used in patients with patellar tendon lengths that are longer than average to avoid GTM.