Two-Incision Anterior Cruciate Ligament Reconstruction

Two-incision anterior cruciate ligament reconstruction (ACLR) is a well-established technique used to perform an arthroscopically assisted ACLR. Historically, this approach to ACLR was once considered the benchmark; however, with evolving arthroscopic technology and the rise of more minimally invasive techniques, this approach to ACLR has become less popular. The two-incision technique still has notable clinical utility because it can (1) increase the surgeon's ability to perform a single-stage revision ACLR and (2) help avoid graft-tunnel mismatch in primary ACLR with a patellar tendon autograft when encountering a long tendon. This technique, when coupled with metal screws and an autograft tendon, is also the lowest cost ACLR technique that allows independent femoral tunnel positioning and thus should be considered as an option for primary ACLR by surgeons prioritizing cost containment without compromising surgical outcomes.