Anatomical rectangular tunnel ACL reconstruction with a bone-patellar tendon-bone graft: its concept, indication and efficacy

Konsei Shino, Tatsuo Mae, Ryohei Uchida, Hiroyuki Yokoi, Tomoki Ohori, Yuta Tachibana


The anatomical rectangular tunnel (ART) ACL reconstruction (ART ACLR) with a single bone-patellar tendon-bone (BTB) graft was developed under the concept of closely replicating the normal ACL. This technique makes it possible (I) to mimic internal fiber orientation inside the ACL, (II) to maximize the graft-tunnel wall contact. Our follow-up study showed that 95% of the patients restored satisfactory stability of the knee with normal motion maintained without extra-articular tenodesis or reconstruction of the anterolateral structures. ART ACLR with a BTB graft can stabilize the knee without loss of motion by closely mimicking the native ACL.