The true story of the original "All-Inside" technique for biological ACL reconstrution Scientific background - Biological rationale - Biomechanical rationale

Reconstruction using the bone-patellar tendon-bone graft has many disadvantages compared to that using the hamstrings tendon including inferior patellar contracture, quadriceps weakness, extension deficits, anterior knee pain, as well as donor site morbidity such as patellar fractures. The “All-Inside” technique is based on the Rosenberg technique using half tunnels and quadrupled hamstrings. To solve the problem of the slow integration of the graft, animal studies were carried out which showed that integration is much more effective when manual versus motorized drilling is used. The technique was not meant to be limited by the use of special instrumentation or the choice of graft. The use of GR-ST autograft presents new issues. Hamstrings have the role of protecting the ACL in elongation during jumping, stopping and cutting movements. The peculiarity of the half tunnels in the “All-Inside” technique allows the surgeon to use only one hamstring thus restoring strength and function to the ACL.