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

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomedical Engineering

Background:

• Bone-patellar tendon-bone (BPTB) autograft is a common choice for anterior cruciate ligament reconstruction (ACLR).
• Traditional screw fixation methods carry risks like graft damage and loss of tension.
• All-inside reconstruction techniques, typically for soft-tissue grafts, offer advantages over traditional full tunnels.

Purpose of the Study:

• To present a novel surgical technique for ACLR utilizing an all-inside approach with a BPTB autograft.
• To highlight the potential benefits of all-inside fixation compared to conventional screw fixation in ACLR.

Main Methods:

• A specific patient profile is indicated, excluding those with patella alta.
• Preoperative imaging and a standardized graft measurement table are used.
• The technique involves harvesting a BPTB autograft, creating all-inside femoral and tibial tunnels, and securing the graft with adjustable loop fixation.

Main Results:

• No prior studies have reported outcomes for all-inside BPTB ACLR.
• Existing research on all-inside soft-tissue grafts suggests improved patient-reported outcomes, reduced tunnel widening, better knee laxity, and less pain.

Conclusions:

• The described all-inside ACLR technique with a BPTB graft is presented as safe and straightforward.
• This technique potentially avoids complications associated with traditional screw fixation.
• It leverages the benefits of all-inside tunnel fixation for ACLR.