All-Inside Anterior Cruciate Ligament Reconstruction: A Review of Advance and Trends

Abstract

Anterior cruciate ligament (ACL) injury is a common disease in orthopedics and mostly occurs as a noncontact injury in athletes. Patients' knee joint stability, which is crucial to their athletic ability, cannot be restored through conservative treatment; it can only be restored through ACLR (ACL reconstruction) surgery. The surgical techniques of ACLR are constantly evolving, from bone tendon bone (BTB) grafting combined with interface screw fixation to hamstring tendon autograft or allogeneic tendon and of suspension device constructs. In particular, the currently prevalent all-inside technique featuring good cosmetic results and quick recovery of early functions not only ensures the stable fixation of grafts but also reduces surgical trauma. This review compares the advantages and disadvantages of different aspects of all-inside ACLR, including graft selection and preparation, bone socket reconstruction, fixation methods, and surgical technique effects and limitations. It has been found that the all-inside technique excels both anatomically and clinically but still requires further development. Besides, it has some limitations, and high-quality randomized controlled trials are still required to compare the long-term effects of the all-inside technique and other ACLR techniques.

The healing effect of the all inside technique is superior to the traditional technique in the reconstruction of the anterior cruciate ligament

“…This preservation is particularly important for maintaining knee stability and facilitating early rehabilitation. 37 , 38 Patients in the all inside technique group are less likely to experience the destabilizing effects of extensive tissue disruption, which can impede early functional recovery. Additionally, all inside technique minimizes tissue disruption during ACL reconstruction surgery.…”

Morphometry of the patellar tendon using a simple tracing method: a gold standard for anterior cruciate ligament reconstruction

“…Graft augmentation ( i.e ., making the graft larger in size by using an allograft, a hybrid construct or harvesting another tendon) is also not a requirement but this is often the case in a traditional ACL reconstruction technique where a surgeon may not be able to accurately pre-determine the size of the preferred graft or in a case of non-envisaged complication or discovery during surgery [ 45 ]. An all-inside technique also offers less morbidity as there is no need to harvest bone blocks which may lead to donor site morbidity, patellar instability, or fracture as is the case for a BPTB [ 45 , 46 ]. However, an all-inside technique requires a single–use special equipment for the retrograde drilling of the sockets thus it is relatively more expensive [ 44 ] and special arthroscopic skills are required [ 45 ] which often makes the PT a preferred graft.…”

All-Inside ACL Reconstruction: Short Femoral and Tibial Socket Technique

“…Advantages of the all-inside ACLR with short socket technique include circumferential filling of the socket with the graft, increasing bone and graft contact compared with interference screw fixation, 7 less bone loss compared with conventional ACL tunnels, 9 and preserving the gracilis muscle, potentially reducing muscle strength loss of the affected limb. 10 Potential disadvantages include the risk of the graft bottoming out during tensioning and fixation, the graft is longer than the tibial socket, 6 and the potential for graft micromotion with suspensory fixation.…”