Anatomical femoral tunnel creation: outside-in versus anteromedial portal

If tunnels are created in the anatomical anterior cruciate ligament (ACL) attachment areas, the graft is able to mimic the orientation of the native ACL without impingement to the femoral notch or posterior cruciate ligament (PCL), leading to successful ACL reconstruction. This article describes the exact location of the ACL femoral attachment area and its landmarks based on histological study, the rationale behind creating anatomic tunnels, and a description of how to create anatomic tunnels during ACL reconstruction.