1. Bicruciate Knee Ligament Reconstruction Using 4 All-Anterior Arthroscopic Portals 
Robert Petretta, M.D., F.R.C.S.C., Vipul Mandalia, M.B.B.S, F.R.C.S.C. 
Arthroscopy Techniques 
Volume 5, Issue 4, Pages e787-e792 (August 2016)
DOI: /j.eats
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2. Fig 1
Portal placement of the right knee in flexion, for bicruciate ligament reconstruction using a high anterolateral (AL), low AL, high anteromedial (AM), and low AM portals. These portals are marked in relation to the patella, patellar tendon, and joint line.
Arthroscopy Techniques 2016 5, e787-e792DOI: ( /j.eats )
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3. Fig 2
(A) With the right knee placed in flexion, a passing guide wire pin is inserted from the low anterolateral portal while viewing through a high anterolateral portal using a 30° arthroscope. (B) The intra-articular view of the passing guide wire pin inserted from the low anterolateral portal into the location of the anterolateral bundle of posterior cruciate ligament (PCL) on the medial femoral condyle while viewing from the high anterolateral portal.
Arthroscopy Techniques 2016 5, e787-e792DOI: ( /j.eats )
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4. Fig 3
With the right knee placed in flexion, a depth gauge is inserted from the low anterolateral portal while viewing through a high anterolateral portal using a 30° arthroscope.
Arthroscopy Techniques 2016 5, e787-e792DOI: ( /j.eats )
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5. Fig 4
(A) With the right knee placed in flexion, a cannulated drill is inserted over the guide wire pin from the low anterolateral portal while viewing through a high anterolateral portal using a 30° arthroscope. The drill width corresponds to the measured graft diameter of the posterior cruciate ligament. (B) The intra-articular view of the cannulated drill passed over the guide wire pin, inserted from the low anterolateral portal while viewing from the high anterolateral portal.
Arthroscopy Techniques 2016 5, e787-e792DOI: ( /j.eats )
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6. Fig 5
(A) The tibial PCL tunnel footprint is cleared using a combination of a curved shaver (Dyonics Electroblade, Smith & Nephew, Andover, MA) and Super Multivac 50 Coblation wand (Smith & Nephew). (B) With the right knee in flexion, a fluoroscopic view is shown using a curved arthroscopic shaver for the tibial tunnel preparation. A 70° arthroscope is placed through the high AL portal, whereas the curved shaver is placed through the high AM portal. (C) An arthroscopic view from a 70° arthroscope placed in the high AL portal of the coblation wand (placed in the high AM portal) clearing the PCL footprint. (AL, anterolateral; AM, anteromedial; PCL, posterior cruciate ligament.)
Arthroscopy Techniques 2016 5, e787-e792DOI: ( /j.eats )
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7. Fig 6
(A) With the right knee in flexion, a PCL tibial guide is inserted through the high AM portal and placed at the tibial footprint of the PCL under arthroscopic visualization through the high AL portal. (B) The position of the tunnel is also checked with fluoroscopy under a lateral view of the knee aiming to be approximately 1.5 cm distal to the articular margin of the posterior tibial plateau, in the tibial footprint of the PCL. (C) The exit location of the passing pin is visualized under direct visualization with the 70° arthroscope through the high anterolateral portal. (AL, anterolateral; AM, anteromedial; PCL, posterior cruciate ligament.)
Arthroscopy Techniques 2016 5, e787-e792DOI: ( /j.eats )
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8. Fig 7
(A) With the right knee in flexion, the endobutton-allograft construct is fed into the tibial tunnel and into the joint. A suture manipulator is placed through the low AM portal that aids to push the graft around the posterior corner of the tibia while pulling on the graft. Visualization at this point is with a 70° arthroscope placed in the high AL portal. (B) Arthroscopic view showing the final bicructaie ligament reconstruction once both the ACL and PCL have been fixed in position. (ACL, anterior cruciate ligament; AL, anterolateral; AM, anteromedial; PCL, posterior cruciate ligament.)
Arthroscopy Techniques 2016 5, e787-e792DOI: ( /j.eats )
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