The anterior cruciate ligament (ACL) TightRope RT (TR) was recently introduced as a novel cortical suspension device for ACL reconstruction. It has an adjustable graft loop that gives the surgeon some advantages during ACL reconstruction. We report three patients who required removal of the TR after an outside-in anatomical ACL reconstruction because of lateral knee pain. We assumed that the knee pain was associated with friction between the TR button of the posterolateral bundle and iliotibial band (ITB). Placing the TR button close to the lateral epicondyle and tissue interposition between the TR button and lateral femoral cortex may be potential risk factors for ITB irritation. Therefore, we recommend not placing the TR button close to the top of the lateral epicondyle and reducing the tissue interposition between the TR button and lateral femoral cortex as much as possible.