All-inside ACL: retroconstruction controversies

All-inside anterior cruciate ligament reconstruction is controversial because the technique is new; as a result, evidence-based clinical outcome studies have yet to be published. The purpose of this article is to consider the following controversies (considered alphabetically): anatomy, biomechanics, biology, bioabsorbables, divergence of the femoral interference screw, expansion or widening of tunnels, fixation, future considerations, graft choice, the learning curve, technique, tensioning, and tibia blow-out fracture. The technique should be learned in stages. In the opinion of the author, the history of sports medicine and arthroscopy has been a progression toward less invasive techniques. In the future, all-inside anterior cruciate ligament reconstruction techniques should become more simple and reproducible, and clinical outcomes must be analyzed with long-term follow-up.