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

Background: Bone-patellar tendon-bone (BPTB) graft for anterior cruciate ligament (ACL) reconstruction (ACLR) is the second most common graft worldwide and the most common graft in the United States. Fixation generally consists of screws, which can have risks, such as graft damage or cutting, loss of tension, or suture breakage while fixating. All-inside reconstruction is generally used for soft-tissue grafts and has advantages over full tunnels. Therefore, we present a technique for ACLR using an all-inside BPTB autograft. Indications: Patient with symptomatic ACL stability and no signs of patella alta, as this increases the risk of graft-tunnel mismatch. Technique Description: Preoperative magnetic resonance imaging is reviewed for tendon length, along with the Ohio State University Graft Metrix Table, which is presented. The patient is positioned supine in a leg holder. Standard anterior incision for patellar tendon harvest is performed, paratenon is preserved, and a 13-mm long and 10-mm wide patellar bone block is harvested along with the middle-third patellar tendon and a 15 to 20 mm long and 10-mm wide tibial bone block. The tibial side is prepared for the femoral tunnel using standard adjustable loop fixation with a cortical button, and the patellar side for the tibial tunnel using quadriceps tendon adjustable loop fixation. Standard femoral and tibial all-inside tunnels are drilled with maximum sockets, and the graft is passed from the anteromedial portal into the joint, the bone plugs are pulled into the sockets, and the adjustable loop fixation is tightened. Results: No studies have reported on outcomes of all-inside BPTB ACLR. Soft-tissue graft all-inside fixation has been shown to lead to better patient-reported outcomes, less tunnel widening, better knee laxity, and less pain. Discussion/Conclusion: The all-inside ACLR with a BPTB graft is a safe and straightforward technique that can be performed using standard equipment. It has the aforementioned benefits of all-inside tunnel sockets and prevents the potential complications of screw fixation. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. Level of Evidence: Level 5.