Traditional single-bundle ACL reconstruction can better control anterior-posterior stability of the knee, but poorly control rotational stability; double-bundle anatomical reconstruction of the ACL can better restore the normal ACL anatomical structure and control joint stability well, but the operation time is long, costly, and technically demanding. Recent studies have shown that single-beam anatomical reconstruction of ACL can better restore the anatomical structure and function of ACL, and postoperative joint stability can be achieved with lower cost and lower technical requirements than double-beam reconstruction. Using the tibial positioning femoral tunnel (Transtibial) technique is often unable to reconstruct the femoral tunnel anatomically, and many scholars have proposed different improved methods. Professor Joon Kyu Lee from Korea used a new modified tibial positioning technique for single-bundle anatomical reconstruction of the ACL and compared it with the anteromedial technique, and the results were published in the recent JBJS. A total of 151 patients were treated with the modified tibial positioning technique and 52 patients with the anteromedial technique from September 2007 to November 2010, and 52 of the 151 patients were retrospectively selected (the basic preoperative conditions were the same as those in the anteromedial group); 52 patients in each of the final modified and anteromedial groups were included in the study. All patients included in the study had no other major ligament injuries or fractures, and all used the autologous quadriceps tendon, with at least 24 months of follow-up and 2 weeks of postoperative CT plain scan. Modified tibial positioning technique An anteromedial incision (4-5 cm below the joint line, 2-3 cm posteriorly within the tibial tuberosity, 1 cm above the goose foot attachment point, and anterior to the medial collateral ligament) was taken, the knee was flexed 90o, and a 60o tibial locator was positioned midway between the anteromedial bundle footprint and the posterior lateral bundle footprint, and a 10-mm tibial bone tract was established by routine operation; the knee was maintained at 90o flexion, and a 7-mm diameter femoral locator was placed, while The tibia was given a force of anterior displacement, internal rotation, and external rotation (Figure 1), and the femoral locator was positioned at the lateral bifurcation ridge of the intercondylar fossa on the medial aspect of the lateral femoral condyle, and a 10-mm femoral tract was established through the tibial bone tract by routine operation. Figure 1 ? Intraoperative tibial force directions given: 1 anterior, 2 medial, 3 lateral rotation Anteromedial technique An anteromedial incision (above the goose foot attachment point, flat tibial tuberosity, between the tibial tuberosity and the medial collateral ligament) is taken, 55o tibial locator, positioned midway between the anteromedial bundle footprint and the posterior lateral bundle footprint, and a 10mm tibial bone tract is established by routine manipulation; the knee is flexed 120o and the femoral locator is positioned on the medial aspect of the lateral femoral condyle at the The lateral bifurcation ridge of the intercondylar fossa was positioned, and a 10-mm femoral bone tract was established through the tibial bone tract in a routine procedure. All grafts were fixed with metal interface screws on the femoral side, bioresorbable screws in the tibial tract, and the tendon tail was fixed with double cortical screws 1 cm below the external tibial tract. Postoperative rehabilitation: postoperative full extension fixation, restriction of flexion 0o-90o with restriction brace for 4 weeks postoperatively, full flexion for 6 weeks postoperatively; gradual partial weight bearing for 6 weeks postoperatively to ensure recovery of quadriceps strength and full activity after 6 months postoperatively. Two-dimensional CT scan was performed 2 weeks after surgery to evaluate graft tilt (as in Figure 2), three-dimensional CT to evaluate bone tract length and tract positioning (as in Figure 3), and anterior drawer test, Lachman test, axial shift test, KT-2000 test for anterior displacement, modified Lysholm score, Tegner score, and IKDC score were performed at the final follow-up. Figure 2 Upper panel: angle between femoral tract and anteroposterior femoral axis in cross-section (FAA), middle panel: angle between femoral and tibial tract medial port connection and joint line in coronal plane (JGC), lower panel: angle between femoral and tibial tract medial port connection and joint line in sagittal plane (JGS) The authors found that the graft tilt FAA modified group was smaller than anteromedial group, and there was no significant difference between JGC and JGS groups; femoral tract length The modified group was longer than the anteromedial group, and the tibial bone tract length modified group was shorter than the anteromedial group; the femoral positioning modified group was more anterior-inferior than the anteromedial group, but there was no significant difference between the two groups. There was no significant difference in knee stability and score at the last follow-up between the two groups. Figure 3 Upper panel: quadratic analysis of femoral positioning, middle panel: anatomic axial analysis of femoral positioning, lower panel: quadratic analysis of tibial positioning The anteromedial technique of anatomic positioning of the femoral tract sometimes requires an additional auxiliary incision and relatively limited field of surgery with 120o knee flexion; these problems can be avoided by using the authors’ modified tibial positioning technique. The authors note that this technique has a shorter tibial tract length (32.3 ± 3.1) than the anteromedial technique, but >28 mm is sufficient for stable fixation of the graft; the use of a 7 mm femoral locator also facilitates internal and external rotation in the 10 mm tibial tract. (Translator’s note) Single-beam anatomic reconstruction of the ACL can restore both the ACL anatomy and provide adequate knee stability, and is more commonly used clinically; this technique requires only one intraoperative application of anterior, internal, and external rotation of the tibia, and is easy to perform and may be tried.