What is Anatomic “All Inside” ACL Reconstruction?

The anterior cruciate ligament (ACL) connects the femur to the tibia in the center of the knee joint and is one of the most commonly injured ligaments. With 25+ years of specialized expertise in orthopedic sports medicine, Dr. Karas has published research on ACL injuries and regularly performs the anatomic “all inside” ACL reconstruction technique at the Emory Sports Medicine Complex to allow patients to quickly return to an active lifestyle.

man playing tennis | anatomic all inside ACL reconstruction

Traditional, invasive ACL reconstruction methods:

  • Surgeon splits the muscle to make a leg incision, resulting in post-op pain and swelling due to tissue trauma
  • A full tunnel is drilled in the tibia, leaving the reconstruction vulnerable to widening or loosening as fluid can fill the space over time
  • Multiple incisions are made, leaving the patient with a less than ideal cosmetic result

“All inside” ACL reconstruction:

  • Minimally invasive (as opposed to open surgery, in which the surgeon must split the muscle to make an incision)
  • During surgery, a narrow, blind-ended tunnel (closed at one end) is drilled from the inside of the knee joint into the tibia, leaving more bone in place and preventing the possibility of fluid entering the open space
  • ACL is reconstructed with a graft (living tissue from the patient’s own body/a donor)
  • Performed under general anesthesia/nerve block that also serves to control post-op pain
  • More ideal cosmetic outcome with fewer incisions
  • Results in less tissue trauma, less post-op pain, and faster, more dependable rehabilitation than traditional surgery

Who is a good candidate?

In the past, older or arthritic patients would not have been good candidates for ACL surgery. But due to advancements in surgical techniques, there is no age limit for “all inside” ACL reconstruction.

Anatomic “All Inside” ACL Surgery could be a solution for your knee pain, if you:

  • Participate in sports that stress the ACL
  • Have undergone failed prior ACL reconstruction surgery
  • Have chronic or long standing ACL injuries with increased knee looseness
  • Have hyperextension (injury involving forceful joint extension beyond natural limits)
  • Have mild limb malalignment (incorrect alignment resulting in instability and pain)