All-Inside Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) graft is commonly performed. Fixation is traditionally performed with interference screws, which has certain disadvantages as the tendon can be damaged or cut during insertion or tension can be lost when inserting the tibial screw. For soft-tissue grafts, all-inside ACLR with blind sockets has gained increased interest over the past 2 decades and has several advantages over the use of full tunnels. Randomized trials have shown better patient-reported outcomes, less pain, and less tunnel widening with all-inside ACLR. Generally, all-inside ACLR is not considered with BPTB grafts because there is a fear of graft-tunnel mismatch, but this can be avoided by paying attention to patellar tendon length and patient height. In this article, we present an all-inside technique for BPTB ACLR using standard equipment that is reproducible with a low risk of graft-tunnel mismatch.