Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using the Translateral Technique

Abstract

There is growing evidence that anatomic placement of the femoral tunnel in anterior cruciate ligament reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic anterior cruciate ligament reconstruction has many well-described technical challenges. This article describes the translateral all-inside technique, which produces anatomic femoral tunnel placement using direct measurement of the medial wall of the lateral femoral condyle and outside-in drilling. All work is carried out through the lateral portal with all viewing through the medial portal. Thus there is no need for an accessory medial portal or hyperflexion of the knee during femoral socket preparation. A single quadrupled hamstring graft is used with cortical fixation at both the femoral and tibial tunnels.T ranstibial drilling remains the most popular method for creating the femoral tunnel in anterior cruciate ligament (ACL) reconstruction. With this technique, femoral socket placement is dictated by the tibial tunnel, which invariably results in a relatively vertical position of the graft. Although this technique has had good early clinical outcomes, the procedure has been shown to be nonanatomic.

Combined All-Inside Anterior Cruciate Ligament Reconstruction and Minimally Invasive Posterolateral Corner Reconstruction Using Ipsilateral Semitendinosus and Gracilis Autograft

“…All-inside ACL reconstruction facilitates anatomic placement of the graft. 15,16 This more accurately replicates the biomechanics of the native ACL and more accurately restores knee kinematics in comparison to nonanatomic reconstruction. 15,17 Specifically, traditional transtibial graft placement tends to place the femoral tunnel high and deep within the intercondylar notch with respect to the ACL footprint, creating a vertically oriented graft that fails to restore rotational stability.…”

“…15,16 This more accurately replicates the biomechanics of the native ACL and more accurately restores knee kinematics in comparison to nonanatomic reconstruction. 15,17 Specifically, traditional transtibial graft placement tends to place the femoral tunnel high and deep within the intercondylar notch with respect to the ACL footprint, creating a vertically oriented graft that fails to restore rotational stability. 18,19 The use of retrograde sockets in lieu of tunnels is boneconserving and minimizes the risk of convergence with the femoral tunnel of the PLC reconstruction.…”

“…22 The technique also obviates the need for hyperflexion of the knee, which carries the risk of iatrogenic cartilage injury during femoral drilling, among others. 15 Furthermore, the technique allows simultaneous restoration of PLC stability, while still using only the ipsilateral hamstrings, thus avoiding donor site morbidity.…”

Early Outcomes in Anterior Cruciate Ligament Reconstruction: Full Tibial tunnel technique compared to all-inside technique

“…Anatomically reconstruction of the ACL is considered a gold standard in the world of orthopedics as it provides a facile graft placement, better outcomes and lower pain after surgery. The most common graft used in all-inside technique is the quadrupled semitendinosus tendon, therefore preserving hamstring strength and allowing a faster rehabilitation and return to daily activities [3,12,13].…”

“…Anterior cruciate ligament (ACL) reconstruction is being performed more than 100.000 times in a year only in the United States [1]. The full tibial tunnel technique is considered a standard technique by many surgeons, whereas in the all-inside technique, the the tibial tunnel is replaced by a tibial socket [2][3][4][5]. Older studies concluded that all-inside technique had a faster rehabilitation time and pain after surgery is slightly diminished [4].…”