Review ArticlesTechniques for Femoral Socket Creation in ACL ReconstructionMatthewson, Graeme MD; Macdonald, Peter MD, FRCSCAuthor Information Pan Am Clinic Foundation, University of Manitoba, Winnipeg, MB, Canada Disclosure: The authors declare no conflict of interest. Reprints: Graeme Matthewson, MD, 46 Salme Drive, Winnipeg, MB, Canada R2M1Y7. Sports Medicine and Arthroscopy Review: June 2020 - Volume 28 - Issue 2 - p 56-65 doi: 10.1097/JSA.0000000000000281 Buy Metrics Abstract Anterior cruciate ligament (ACL) injury is common and affects a wide variety of individuals. An ACL reconstruction is the treatment of choice for patients with subjective and objective symptoms of instability and is of particular importance to cutting or pivoting athletes. With many variables involved in ACL reconstruction, femoral tunnel placement has been found to affect clinical outcomes with nonanatomic placement being identified as the most common technical error. Traditionally the femoral tunnel was created through the tibial tunnel or transtibial with the use of a guide and a rigid reaming system. Because of proximal, nonanatomic tunnel placement using the transtibial technique, the use of the anteromedial portal and outside-in drilling techniques has allowed placement of the tunnel over the femoral footprint. In this paper, we discuss the difference between the 3 techniques and the advantages and disadvantages of each. The authors then explore the clinical differences and outcomes in techniques by reviewing the relevant literature. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.