ACL Injury and Graft Trends in NFL Players

Besides graft choice, there is also significant variability in the tunnel drilling preferences of physicians performing ACLR in elite athletes.  There is debate on whether or not transtibial drillings place the tunnel within the native ACL footprint [10-11].  Additional studies challenge that non-anatomical tunnel placement results in inferior restoration of joint kinematics compared with anatomical ACLR achieved by independent, transportal drilling [12].  A study evaluating ACLR practice patterns in elite athletes in the USA showed that 44.7% of surgeons drilled the femoral tunnel through a transtibial portal, 36.2% through an anteromedial (AM) portal and 12.8% by a two-incision technique [13].  Interestingly, on an international survey performed in 2011, 68% of surgeons performed AM portal drilling over the traditional transtibial portal (31%) [9].