Endoscopic reaming of the femoral tunnel has several advantages over "two-incision" techniques but has a greater potential for posterior cortical violation. Proper guide pin placement and adequate knee flexion during endoscopic reaming are key to avoiding posterior cortical violation. When the posterior femoral cortex is compromised, options include "over-the-top" graft passage and fixation with screw and post or conversion to the traditional "two-incision" technique. The two-incision tunnel should be started more anterior on the lateral femoral cortex to achieve greater divergence from the endoscopic tunnel. This may allow interference screw fixation of a patella tendon anterior cruciate ligament graft. This article examines the technical factors affecting the development of posterior cortical violation and discusses options for management.