Anatomic single-bundle anterior cruciate ligament reconstruction. A, Saline arthroscopy bag is secured to table to assist in maintaining knee flexion. B, Increase in tibial guide angle. Length of tunnel can be increased. C, Tibial tunnel using inner edge of lateral meniscus and medial tibial spine as reference points. Tibial tunnel should be reamed into edge of medial spine and should be centered just slightly anterior to inner edge of lateral meniscus. D, Three reference points—inner edge of lateral meniscus, base of medial spine, and posterior cruciate ligament—are used for tibial guidewire. E, Tibial tunnel should be posterior to roof of altered intercondylar notch to prevent graft impingement in knee extension. F, Note position of femoral tunnel, about 4 to 5 mm off articular surface and 2 to 3 mm anterior to over-the-top spot. G, With knee flexed more than 100 degrees, guidewire is placed up femoral tunnel through middle cannula. Interference screw is passed, ensuring that guidewire and traction suture is straight line and ensuring minimal divergence between screw and bone plug. H, Use of sheath to protect graft and to assist in placing screw parallel to graft. SEE TECHNIQUE 51.16.