To address the technical limitations of the conventional transtibial technique and the steep learning curve associated with double-bundle anterior cruciate ligament (ACL) reconstruction, we have defined a novel "footprint" technique that reliably allows for anatomic single-bundle ACL reconstruction with minimal technical complications. The technique merges the principles of carefully defining the ACL footprint anatomy with the use of a modified anteromedial portal reaming technique with a flexible guidewire and reaming system. The procedure offers the advantages of an anatomic ACL reconstruction by use of anteromedial portal reaming techniques while avoiding the significant technical risks and pitfalls associated with double-bundle reconstruction. Our experience in over 100 footprint ACL reconstructions has been met with excellent clinical success with minimal intraoperative or postoperative complications. The purpose of this article is to outline the key steps of our defined procedure that are critical to achieving a successful outcome.
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