Abstract
Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed
knee operations. An “all-inside” technique creates bone sockets for ACL graft passage,
as opposed to more traditional full bone tunnels, and typically incorporates suspensory
fixation instead of screw fixation to secure the graft. This technique may be indicated
for any ACL reconstruction surgery, where adequate bone stock exists to drill sockets
and to use cortical fixation. The technique may be used with all soft tissue, as well
as bone plug ACL grafts and autograft hamstring or quadriceps tendon; most allograft
tendon options may be performed with an all-inside technique. Advantages include anatomic
tunnel/socket placement, decreased postoperative pain and swelling, minimal hardware,
appropriate graft tensioning and retensioning, and circumferential graft to bone healing.
Tips for successful all-inside surgery include matching graft diameter to socket diameter,
drilling appropriate length sockets based on individual graft length, so as not to
“bottom out” the graft and confirming cortical button fixation intraoperatively. Potential
complications include graft-socket mismatch, full-tunnel reaming, and loss of cortical
fixation. Multiple studies have shown the all-inside technique to have similar or
superior biomechanical properties and clinical outcomes compared to the more traditional
full-tunnel ACL reconstruction techniques.
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Bibliography
- Transportal versus all-inside techniques of anterior cruciate ligament reconstruction: A systematic review.J Orthop Surg Res. 2021; 16: 734
- A comparison of two-year anterior cruciate ligament reconstruction clinical outcomes using all-soft tissue quadriceps tendon autograft with femoral/tibial cortical suspsensory fixation versus tibial interference screw fixation.Arthroscopy. 2022; 38: 881-891
- All-inside anterior cruciate ligament graft-link technique: Second-generation, no-incision anterior cruciate ligament reconstruction.Arthroscopy. 2011; 27: 717-727
- Cortical suspensory button versus aperture interference screw fixation for knee anterior cruciate ligament soft-tissue allograft: A prospective, randomized controlled trial.Arthroscopy. 2015; 31: 1733-1739
- Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorable screw compared to an all-inside technique with suspensory fixation.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2577-2584
- Clinical and functional outcome of all-inside anterior cruciate ligament reconstruction at a minimum of 2 years’ follow-up.Arthroscopy. 2016; 32: 332-337
- Editorial Commentary: With appropriate anterior cruciate ligament graft selection, all-inside reconstruction results in excellent outcomes: Stay “inside” and be cognizant of hamstring graft diameter expectations in shorter patients.Arthroscopy. 2021; 37: 3149-3151
Article info
Publication history
Accepted:
June 1,
2022
Received:
April 22,
2022
Footnotes
The authors report the following potential conflicts of interest or sources of funding: H.S.S. reports research support from Arthrex for the use of Fibertag implants for quadriceps tendon ACL grafts. B.C.B. reports consulting fees from Stryker Sports Medicine. He also reports that he is president of Texas Society of Sports Medicine and the President Elect of the Texas Orthopedic Association. C.N. reports consulting fees from Guidepoint Consulting, Arthrex, Inc., and Vericel, Inc.; meeting travel support from AO International and Arthrex; and board or committee membership of the Arthroscopy Journal, AANA, AOSSM, and AAOS. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
