It is an even less invasive technique, which causes less tissue injury, replaces the cut cruciate with a single tendon (graft) instead of two or the patellar, less bone removal is done and can be applied to teenagers who are not yet skeletally mature . Less post-operative pain, excellent stability and faster return to daily and sports activities, are some of its benefits for the patient.
Anterior Cruciate Ligament Rupture and Treatment

“Anterior cruciate ligament tear is one of the most common knee injuries, especially in athletes and dancers. The “correct” therapeutic treatment, conservative or surgical, depends on the unique needs of each patient: his age, the type of work, his sports activities, any coexisting injuries and the degree of instability”, points out Mr. Anastasios Deligeorgis MD, MSc. Orthopedic Surgeon-Sports Physician Deputy Director of the 3rd Orthopedic Clinic of the hospital HEALTH. And he continues: “In young athletes and active people with a complete cruciate tear, surgical treatment is recommended. Because the anterior cruciate ligament has little healing capacity in contrast to other ligaments, despite any conservative treatment the instability of the knee usually remains and its function is not restored.”
The All INSIDE Arthroscopic Technique

The orthopedic surgeon will replace the torn anterior cruciate ligament (ligamentoplasty) with a graft from the patient himself. The operation is performed with arthroscopy, a minimally invasive technique, through holes of just a few millimeters and a small incision.
Ligandoplasty with the modern All Inside arthroscopic technique is considered an extremely demanding operation and its success largely depends on the expertise and experience of the orthopedic surgeon.
The stages of the All INSIDE technique:
Selection of graft

“As a graft it is chosen hamstrings of the patient instead of the patellar tendon which requires an incision on the anterior surface of the knee and has been blamed for anterior knee pain.
In place of the cut anterior cruciate ligament, a single tendon (graft) from the hamstrings, the Semitendinosus, is placed instead of two tendons used in the classic technique. A tendon is thus saved (the lean), resulting in better function retention, greater knee muscle strength and less post-operative pain.
Although a single tendon is used, the semitendinosus, because of its greater thickness, can be fashioned into a quadruple-bundle, higher-strength graft.
Fixation of the graft

The retention and stabilization of the graft is done with special “buttons” (suspended systems with Buttons) outside the bone, in the femur and tibia, and no screws or other materials that go into the bone are used.
In this way, much smaller channels are opened in the bones compared to the larger channels that are created when materials are inserted into them. Smaller channels mean less pain and faster healing. The bone cortex is preserved almost intact which contributes to better retention and stronger integration of the graft.
Review

In the event of re-injury and graft rupture, revision of the ACL reconstruction is easier.
Regarding children-teenagers
Here, the injury to the epiphyseal plate (growth cartilage) of the tibia is minimal and thus, the chances of any problems occurring in their development are essentially zero,” concludes the expert.
Advantages in relation to the Classical Technique

• A second tendon is saved from being used as a graft
• Much smaller channels are made in the bone and therefore, more bone is kept in place
• No materials are required to enter the bones
• Easier to revise, in case of a new rupture of the ACL
Benefits for the Patient

• Less postoperative pain
• Faster and stronger integration of the graft into the bone
• Better aesthetic result
• Faster and better postoperative recovery
• Excellent knee stability
• Regarding children-adolescents, their development is not affected