Table 3.

Advantages and Limitations of the Procedure

Advantages 1.The periosteal sleeve can be harvested through the same incision used to harvest the hamstring tendons. 2.The progenitor cells in the cambium layer of the periosteum facing the tunnel surface differentiate into fibrocartilage and bone, which can result in quicker and better integration of the graft and limit the tunnel widening. 3.The periosteum layer decreases the seepage of synovial fluid into the bone tunnels, which decreases the chances of tunnel widening. 4.Quicker and better integration of graft allows early return to sport.

Limitations 1.Harvesting the periosteal sleeve may contribute to immediate postoperative pain. 2.Adding the periosteal layer to the graft contributes to the overall diameter of the graft by 0.5 mm, and adjustments need to be made with respect to tunnel diameter and length. 3.Operating time might be increased by 10 to 15 min. 4.Common complications of arthroscopic anterior cruciate ligament reconstruction should be considered like deep-vein thrombosis, infection, and knee stiffness after immobilization.