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Ehab Abdelbaki Hussin,1 Asim Aldaheri,1 Hatem Alharbi,1 Hazem A Farouk2 1Orthopedics Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia; 2Orthopedics Department, Faculty of Medicine, Cairo University, Cairo, Egypt Purpose: This study compared the accessory anteromedial portal (AAMP) and the modified transtibial technique (MTTT)” for single-bundle anterior cruciate ligament (ACL) reconstruction. Patients and methods: Sixty active adult patients with ACL tear were randomly assigned into two equal groups who were treated surgically. One group was operated on using AAMP and the other group through MTTT. Both the groups had the same postoperative course and were followed for 1 year after surgery. The follow-up included Lysholm and International Knee Documentation Committee (IKDC) subjective knee evaluation forms, IKDC objective knee examination form, and radiological evaluation. Results were evaluated and compared with each other. Results: There was no significant difference in subjective effects or clinical examination between the two groups. Regarding radiological angles, the AAMP had more oblique graft orientation in the coronal plane than the MTTT, but both were found to be more slanted than native ACL. Also, the MTTT had succeeded to place the graft and tunnel more obliquity than the traditional non-anatomic TTT and better than the anatomic ranges despite having the graft inclination of the AAMP higher than the MTTT. The complaints from the patients and subjective scoring were found to be positively related to graft stability. Patients with healthier preoperative subjective state had a smoother postoperative period and better outcome. Conclusion: This study offers simple modifications to the transtibial technique to allow near anatomic ACL reconstruction with similar results comparable to the AAMP and with fewer complications. Keywords: anterior cruciate ligament, MTTT, AAMP, arthroscopy, orthopedics, ACL, Modified transtibial, anatomic, Art