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The medial portal technique is versatile and can be used with any ACL graft type and any primary, revision, single- or double-bundle ACL reconstruction. The medial portal technique is particularly useful when only one of the ACL bundles is torn, and the surgeon wishes to preserve the remaining intact ACL fibers and augment the injured posterolateral (PL) or anteromedial (AM) bundle. The only contraindication to the medial portal technique when using rigid guide pins and drill bits is the inability to flex the knee to at least 120°. This limitation may be encountered in some obese patients. Case consideration should be given to drilling the ACL femoral tunnel using an outside-in technique or using flexible reamers.
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