A Different Approach to ACL Reconstruction

A Different Approach to ACL Reconstruction

In our recent article A Different Approach to ACL Surgery, we shed some light on ACL repair vs ACL reconstruction and its advantages. Sadly, for the majority of people with an ACL tear, reconstruction is their only viable option. Within this option, there is a non-traditional approach to ACL reconstruction called All-Inside ACL reconstruction, which could result in less pain and reduce your recovery time significantly.

Both traditional ACL reconstruction surgery and All-Inside ACL reconstruction surgery involve replacing the torn ACL with a tendon graft (whether it be a hamstring tendon, patellar tendon or cadaver graft). The difference between traditional ACL surgery and All-Inside ACL surgery is the approach taken, in particular, the drilling of a tibial tunnel.

Traditional ACL reconstruction involves drilling a tunnel from the outer tibial cortex into the proximal tibia and knee joint. Through this tunnel, the ACL graft is inserted and securely fixed onto the tibia. This tibial tunnel can be a significant source of pain following ACL surgery, as the peristeum over the tibial cortex is sensitive and damaging it results in pain similar to that experienced with a fracture. 

However, with All-Inside ACL reconstruction, a tibial tunnel is not created. Instead, a specialized tool is used to create a tibial socket, which does not violate the tibial cortex. All-Inside ACL reconstruction also has the added advantage of not requiring large incisions - three to four small arthroscopy incisions are all you need.

All-Inside ACL reconstruction is an excellent and minimally invasive surgical alternative to traditional ACL reconstruction surgery. The advantages of All-Inside ACL surgery compared to traditional ACL reconstruction surgery include:

  • Less pain following surgery
  • Smaller incisions and less scarring
  • Faster recovery and shorter healing time
  • A more anatomic ACL reconstruction due to the specialized instrumentation used.
All-Inside ACL reconstruction is more technical than traditional ACL surgical approaches. A surgeon with expertise in this technique is a must. 


According to James Klosterman MD, one surgeon with expertise in this area, “The benefits to my patients are that we are able to provide a minimally invasive approach to what has traditionally been a much more involved operation."

"What we’ve seen from our patients is improved early recovery, markedly decreased postoperative pain, better range of motion sooner, and less scarring.”

He further states, “When we see our All-Inside ACL patients back at their first follow-up appointment, most of them have dramatically less swelling and improved range of motion than someone who had the traditional surgery.”

“This allows us to be more aggressive in our therapy and even accelerate our patients in meeting certain goals.”

Source: Premier Health, PH. (2017). Minimally Invasive Procedure Can Transform ACL Reconstruction. Accessed 12th January 2018, from goo.gl/4GAxtw.


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