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Xu J, Jia Y, Zhang B, Wang X, Sun R. Comparison of the Clinical Outcomes between All-inside and Standard Technique in Anterior Cruciate Ligament Reconstruction with 6-strand Hamstring Tendon Autograft. Orthop Surg 2024; 16:1034-1041. [PMID: 38506183 PMCID: PMC11062872 DOI: 10.1111/os.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE All-inside and standard techniques with 4-strand hamstrings graft have been widely used in anterior cruciate ligament (ACL) reconstruction. However, the graft diameter of less than 8 mm will significantly increase the rate of surgical failure, and the 6-strand graft can solve this problem. The purpose of this study is to compare all-inside ACL reconstruction using suspensory cortical button fixation on both tibia and femur with standard ACL reconstruction using suspensory femoral fixation and a bioabsorbable tibial interference screw with a 6-strand hamstring tendon autograft in postoperative clinical outcomes. METHODS From January 2020 to December 2020, 48 patients performed ACL reconstruction were divided into the all-side group and the standard group according to the different surgical techniques. Magnetic resonance imaging (MRI) and subjective function scores was used to assess clinical outcomes at least 24 months following ACL reconstruction. MRI was used to measure the value of bone tunnel widening in articular and middle portions. Subjective function scores included the Lysholm knee score, the International Knee Documentation Committee (IKDC) score, the Knee Society Score (KSS) for pain and function, and KT-1000. The t-test was used assuming the distribution of the patients which follows the normal distribution and we used non-parametric tests if these two conditions were not satisfied. RESULTS At the final follow-up, there were 22 patients in the all-inside group and 24 patients in the standard group. No significant differences were found with respect to femoral tunnel widening and subjective function scores. However, a significant increase in tibial tunnel widening was found in the middle portion of the standard group (2.25 ± 0.74) compared to the all-inside group (0.76 ± 0.24) (p < 0.01) and also in the articular portion of the standard group (2.07 ± 0.77) compared to the all-inside group (1.52 ± 0.54) (p = 0.02). In addition, the value of the KT-1000 was 1.81 ± 0.45 for the all-inside group and 2.12 ± 0.44 in the standard group (p = 0.016). CONCLUSION The objective stability of the knee was relatively better in the all-inside group than in the standard group. And tunnel widening after ACL reconstruction was significantly greater in the standard technique when compared to the all-inside technique on the tibia side.
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Affiliation(s)
- Juncai Xu
- Center for Joint SurgerySouthwest Hospital, Army Medical UniversityChongqingChina
| | - Yanfeng Jia
- Department of Orthopaedic SurgeryHebei Medical University Third Affiliated HospitalShijiazhuangChina
| | - Boxuan Zhang
- Department of Orthopaedic SurgeryThe Eighth People's Hospital of Hebei ProvinceShijiazhuangChina
| | - Xiaofeng Wang
- Department of Orthopaedic SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangChina
| | - Ran Sun
- Department of Orthopaedic SurgeryHebei Medical University Third Affiliated HospitalShijiazhuangChina
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Bosco F, Giustra F, Ghirri A, Cacciola G, Massè A, Capella M. All-Inside Anterior Cruciate Ligament Reconstruction Technique: Tips and Tricks. J Clin Med 2023; 12:5793. [PMID: 37762734 PMCID: PMC10532376 DOI: 10.3390/jcm12185793] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
The all-inside anterior cruciate ligament reconstruction (ACLR) technique was developed to improve patient outcomes by reducing the procedure's invasiveness, minimizing complications and pain, and enabling faster postoperative recovery. This study presents a detailed description of the all-inside ACLR technique, which involves the use of quadrupled semitendinosus (ST) graft and suspension devices at both tibial and femoral sites, as well as valuable tips for avoiding complications that may arise during the procedure. The surgical procedure employs retrograde drills to create bony sockets for graft passage, which are then fixed with suspension devices at both the tibial and femoral sites. This technique has no specific restrictions and may be applied to all patients with anterior cruciate ligament (ACL) injuries. The literature reports the advantages, good clinical outcomes, and medium- to long-term graft survival achieved with the all-inside ACLR technique. However, the complications and disadvantages associated with the technique must be considered.
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Affiliation(s)
- Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino—ASL Città di Torino, 10154 Turin, Italy;
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino—ASL Città di Torino, 10154 Turin, Italy;
| | - Alessandro Ghirri
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino—ASL Città di Torino, 10154 Turin, Italy;
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
| | - Marcello Capella
- Department of Orthopaedics and Traumatology, University of Turin, Centro Traumatologico Ortopedico (CTO), 10124 Turin, Italy; (F.G.); (G.C.); (A.M.); (M.C.)
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Shetty CC, Ming W, Lee YHD. Concomitant Medial and Lateral Meniscus Posterior Horn Root Repair With ACL Reconstruction Using Trans-Tibial Tunnel Technique. Arthrosc Tech 2023; 12:e477-e482. [PMID: 37138685 PMCID: PMC10149901 DOI: 10.1016/j.eats.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/18/2022] [Indexed: 05/05/2023] Open
Abstract
Concomitant medial meniscus posterior horn root tears and lateral meniscus posterior horn root tears are rare in occurrence. There is limited literature on the simultaneous repair of medial and lateral meniscus root tears, with ACL reconstruction. We discuss management of concomitant medial meniscus posterior horn root tear (MMPHRT), lateral meniscus posterior horn root tear (LMPHRT), and anterior cruciate ligament (ACL) tear. We highlight the surgical technique in which we perform a repair of both medial and lateral meniscus posterior horn root repairs with ACL reconstruction. We explain the sequence of such a repair to avoid tunnel coalescence.
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Affiliation(s)
- Chandan C. Shetty
- Address correspondence to Chandan C. Shetty, M.B.B.S., D.Ortho, D.N.B. (Ortho), Department of Orthopaedic Surgery, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074.
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Tuca M, Valderrama I, Eriksson K, Tapasvi S. Current trends in anterior cruciate ligament surgery. A worldwide benchmark study. J ISAKOS 2023; 8:2-10. [PMID: 36154898 DOI: 10.1016/j.jisako.2022.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To benchmark current trends on anterior cruciate ligament reconstruction (ACLR) surgery. METHODS The largest worldwide ACLR survey to date was performed during May 2020, targeted to reach representation of all continents. It was submitted electronically to all International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports surgeons (n = 3,026), asking those who perform ACLR to respond. RESULTS With a final sample size of 2,107, the overall response rate was 69.6%. Median years of practice as orthopaedic surgeon was 15 (range 1-52) and 49.6% of all respondents were defined as high-volume surgeons (>50 ACLR annually). Hamstrings tendon autograft was the preferred graft for primary ACLR (80.3%) and the medial portal femoral drilling was the most frequently used technique (78.5%). Cortical buttons (82.7%) and bioabsorbable screws (62.7%) were the preferred fixation methods for hamstring tendon autograft ACLR in femur and tibia, respectively. Metallic screws (45.2%) were the preferred fixation methods for bone patellar tendon bone autograft in femur and tibia. Most of the respondents routinely used pre-tensioning techniques for their graft preparation (63.8%), but less than half of surgeons preferred antibiotic soaking of the grafts (45.3%). The preferred knee position for graft fixation was 10-30° of knee flexion and neutral rotation (57.0%). The addition of anterolateral augmentation (or extra-articular tenodesis) was infrequent in primary and isolated ACLR (10.0%), but a statistically significant raise was seen for revision surgeries (20.0%). Most used brace in the initial postoperative rehabilitation (54.9%) and the time to allow patients to fully resume sports was at an average of 8.9 ± 2.0 months. Treatment algorithm of paediatric ACL injuries exhibited a low consensus among the respondents. CONCLUSION This worldwide survey benchmarks the current trends in ACL reconstruction, achieving the largest participation of surgeons to date. Among the great variety of options available for ACL reconstructions, surgeons' preferences showed some differences according to their location and expertise. Reporting trends in practice, and not only the evidence, is important to medical education and providing patients the safest care possible. This is a Level V, expert opinion study.
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Affiliation(s)
- María Tuca
- Pontificia Universidad Catolica de Chile, School of Medicine, Chile; Department of Orthopedics, Hospital Clinico Mutual de Seguridad, Santiago de Chile, Chile.
| | - Ignacio Valderrama
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Department of Orthopaedic Surgery, Hospital San José, Santiago, Chile
| | - Karl Eriksson
- Department of Orthopedics, Stockholm Söder Hospital, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Stockolm, Sweden
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Ammann E, Hecker A, Bachmann E, Snedeker JG, Fucentese SF. Evaluation of Tibial Fixation Devices for Quadrupled Hamstring ACL Reconstruction. Orthop J Sports Med 2022; 10:23259671221096107. [PMID: 35592018 PMCID: PMC9112421 DOI: 10.1177/23259671221096107] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Shortcomings to tibial-side fixation have been reported as causes of failure
after anterior cruciate ligament reconstruction. Adjustable-loop suspensory
devices have become popular; however, no comparison with hybrid fixation
(ie, interference screw and cortical button) exists to our knowledge. Purpose: The purpose of this study was to compare the biomechanical properties of
adjustable loop devices (ALDs) in full-tunnel and closed-socket
configurations in relation to hybrid fixation. We hypothesized that primary
stability of fixation by a tibial ALD will not be inferior to hybrid
fixation. Study Design: Controlled laboratory study. Methods: Tibial fixation of a quadrupled tendon graft was biomechanically investigated
in a porcine tibia–bovine tendon model using 5 techniques (n = 6 specimens
each). The tested constructs included hybrid fixation with a cortical
fixation button and interference screw (group 1), single cortical fixation
with the full-tunnel technique using an open-suture strand button (group 2)
or an ALD (group 3), or closed-socket fixation using 2 different types of
ALDs (groups 4 and 5). Each specimen was evaluated using a materials testing
machine (1000 cycles from 50-250 N and pull to failure). Force at failure,
cyclic displacement, stiffness, and ability to pretension the graft during
insertion were compared among the groups. Results: No differences in ultimate load to failure were found between the ALD
constructs (groups 3, 4, and 5) and hybrid fixation (group 1). Cyclic
displacement was significantly higher in group 2 vs all other groups
(P < .001); however, no difference was observed in
groups 3, 4, and 5 as compared with group 1. The remaining tension on the
construct after fixation was significantly higher in groups 3 and 4 vs
groups 1, 2, and 5 (P < .02 for all comparisons),
irrespective of whether a full-tunnel or closed-socket approach was
used. Conclusion: Tibial anterior cruciate ligament graft fixation with knotless ALDs achieved
comparable results with hybrid fixation in the full-tunnel and closed-socket
techniques. The retention of graft tension appears to be biomechanically
more relevant than tunnel type. Clinical Relevance: The study findings emphasize the importance of the tension at which fixation
is performed.
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Affiliation(s)
- Elias Ammann
- Balgrist University Hospital, Zürich, Switzerland
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Bhimani R, Shahriarirad R, Ranjbar K, Erfani A, Ashkani-Esfahani S. Transportal versus all-inside techniques of anterior cruciate ligament reconstruction: a systematic review. J Orthop Surg Res 2021; 16:734. [PMID: 34949188 PMCID: PMC8705139 DOI: 10.1186/s13018-021-02872-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/05/2021] [Indexed: 01/10/2023] Open
Abstract
Background Transportal (TP) and all-inside techniques (AIT) are the most commonly used anterior cruciate ligament (ACL) reconstruction procedures in current clinical practice. However, there is an ongoing debate over which procedure is superior. Therefore, the purpose of this systematic review was to evaluate and compare the clinical outcomes and complications of these two techniques to propose recommendations for future application. Our primary hypothesis was that AIT is a superior ACLR technique compared to TP. Methods A systematic literature review, using PRISMA guidelines, was conducted using PubMed, Medline, Google Scholar, and EMBASE, up to February 2021 to identify studies focusing on AIT and TP techniques of ACL reconstruction. We excluded animal experiments, cadaveric studies, retrospective studies, case reports, technical notes, and studies without quantitative data. Patients’ characteristics, surgical technical features, along with postoperative follow-up and complications were extracted and reported accordingly. Methodological quality of the included studies was assessed using the Modified Coleman Methodology Score (MCMS). Results A total of 44 studies were selected for this review, of which four were comparative studies. A total of 923 patients underwent AIT and 1678 patients underwent the TP technique for ACLR. A single semitendinosus graft was commonly used in the AIT compard to combined semitendinosus and gracilis graft in the TP group. The postoperative increase in International Knee Documentation Committee (IKDC), Lysholm, KT-1000, and Short Form-12 (physical and mental) scores were similar in the AIT group and the TP group. Contrastingly, the VAS pain score was significantly lower in the AIT group compared to the TP group. Furthermore, the pooled complication rates from all studies were similar between the two groups (AIT: 54 patients, 8.26% vs. PT: 55 patients, 6.62%). However, the four studies that prospectively compared AIT and TP techniques showed lesser complications in the AIT group than the TP group. Conclusion Since the future trend in orthopedic surgery is toward less invasive and patients’ satisfaction with good outcomes, AIT is a good alternative method considering preserving bony tissue and gracilis tendon with less post-operative pain, along with more knee flexor strength and equal outcomes compared to conventional ACL reconstruction surgery. Level of Evidence II. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-021-02872-x.
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Affiliation(s)
- Rohan Bhimani
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Keivan Ranjbar
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amirhossein Erfani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran. .,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Soheil Ashkani-Esfahani
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Takahashi T, Watanabe S, Ito T. Current and future of anterior cruciate ligament reconstruction techniques. World J Meta-Anal 2021; 9:411-437. [DOI: 10.13105/wjma.v9.i5.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/09/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
In recent years, anterior cruciate ligament (ACL) reconstruction has generally yielded favorable outcomes. However, ACL reconstruction has not provided satisfactory results in terms of the rate of returning to sports and prevention of osteoarthritis (OA) progression. In this paper, we outline current techniques for ACL reconstruction such as graft materials, double-bundle or single-bundle reconstruction, femoral tunnel drilling, all-inside technique, graft fixation, preservation of remnant, anterolateral ligament reconstruction, ACL repair, revision surgery, treatment for ACL injury with OA and problems, and discuss expected future trends. To enable many more orthopedic surgeons to achieve excellent ACL reconstruction outcomes with less invasive surgery, further studies aimed at improving surgical techniques are warranted. Further development of biological augmentation and robotic surgery technologies for ACL reconstruction is also required.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Sports and Health Science, Ehime University, Matsuyama 790-8577, Ehime, Japan
| | - Seiji Watanabe
- Department of Orthopedic Surgery, Ehime University Graduate School of Medicine, Toon 791-0295, Ehime, Japan
| | - Toshio Ito
- Department of Orthopaedic Surgery, Murakami Memorial Hospital, Saijo 793-0030, Ehime, Japan
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Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation. Knee Surg Sports Traumatol Arthrosc 2019; 27:2577-2584. [PMID: 30406408 DOI: 10.1007/s00167-018-5275-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare clinical outcomes and tunnel widening following anterior cruciate ligament reconstruction (ACLR) performed with an all-inside technique (Group A) or with a bioabsorbable tibial screw and suspensory femoral fixation (Group B). METHODS Tunnel widening was assessed using computed tomography (CT) and a previously validated analytical best fit cylinder technique at approximately 1-year following ACLR. Clinical follow-up comprised evaluation with IKDC, KSS, Tegner, Lysholm scores, and knee laxity assessment. RESULTS The study population comprised 22 patients in each group with a median clinical follow-up of 24 months (range 21-27 months). The median duration between ACLR and CT was 13 months (range 12-14 months). There were no significant differences in clinical outcome measures between groups. There were no differences between groups with respect to femoral tunnel widening. However, there was a significantly larger increase in tibial tunnel widening, at the middle portion, in Group B (2.4 ± 1.5 mm) compared to Group A (0.8 ± 0.4 mm) (p = 0.027), and also at the articular portion in Group B (1.5 ± 0.8 mm) compared to Group A (0.8 ± 0.8 mm) (p = 0.027). CONCLUSION Tibial tunnel widening after ACLR using hamstring tendon autograft is significantly greater with suspensory femoral fixation and a bioabsorbable tibial interference screw when compared to an all-inside technique at a median follow-up of 2 years. The clinical relevance of this work lies in the rebuttal of concerns arising from biomechanical studies regarding the possibility of increased tunnel widening with an all-inside technique. LEVEL OF EVIDENCE III.
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Barbier D, N’Dele D, Bennis M, Thevenin-Lemoine C, De Gauzy JS, Accadbled F. Day surgery for anterior cruciate ligament reconstruction in children: a prospective study on feasibility and satisfaction. J Child Orthop 2019; 13:100-106. [PMID: 30838082 PMCID: PMC6376444 DOI: 10.1302/1863-2548.13.180064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/15/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate the feasibility of day surgery anterior cruciate ligament reconstruction (ACLR) in children. Our hypothesis was that proper patient selection, adequate information and a streamlined clinical pathway would allow for a safe and satisfactory procedure. METHODS A total of 20 patients, seven girls and 13 boys, who underwent outpatient ACLR at mean age of 14 years (8 to 16) were included in this single institution prospective case series. Surgery took place under simple general anesthesia while analgesia protocol combined local anesthesia, oral analgesics for the postoperative period and compressive cryotherapy. The main failure criterion was the inability to return home the day of surgery or the need for rehospitalization during the first week after discharge. Secondary evaluation parameters were the rate of postoperative complications, postoperative pain, quality of life (QOL) and patients' satisfaction outcome questionnaire (PSOQ) at postoperative day 1, 7 and 31. RESULTS Of the 20 patients included, only one failed the ambulatory mode. The mean PSOQ score was, respectively for children and parents, 91.4% and 90.7% at day 7 and 94.6% and 95.7% at one month. Postoperative QOL at day 7 was very satisfying for all patients. Two minor early complications were reported. Both of the late complications, which included one partial wound dehiscence and one persistent knee swelling, resolved spontaneously. CONCLUSION This study indicates that, in a targeted and well-informed population, day surgery for children ACLR yields high level of patient and family satisfaction in a safely manner. LEVEL OF EVIDENCE IV, prospective case series.
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Affiliation(s)
- D. Barbier
- Paediatric Orthopaedic Department, CHU Toulouse, Toulouse, France
| | - D. N’Dele
- Paediatric Orthopaedic Department, CHU Toulouse, Toulouse, France
| | - M. Bennis
- Anesthesia Department, CHU Toulouse, Toulouse, France
| | | | | | - F. Accadbled
- Paediatric Orthopaedic Department, CHU Toulouse, Toulouse, France
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All-inside ACL reconstruction: How does it compare to standard ACL reconstruction techniques? J Orthop 2017; 14:241-246. [PMID: 28360487 DOI: 10.1016/j.jor.2017.03.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/09/2017] [Indexed: 12/23/2022] Open
Abstract
The all-inside ACL reconstruction technique is a relatively new development in ACL surgery. Some features of this technique include closed-socket tunnels, dual suspensory graft fixation, decreased bone removal, and smaller skin incisions. The purpose of this review was to compare the unique features of the all-inside ACL versus standard ACL techniques using biomechanical and clinical studies. The all-inside ACL appears to have similar overall results on subjective and objective outcomes studies compared to standard ACL techniques and may be associated with decreased post-operative pain. There is also a concern for a higher graft failure rate with the all-inside ACL.
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