Table 1.
Indications, Contraindications, Tips, Pearls, Pitfalls, Key Points, and Limitations of Translateral All-Inside Technique for ACL Reconstruction
| Indications |
| ACL deficiency requiring reconstruction, especially when performed as part of multiligament reconstruction. |
| Contraindications |
| Contraindications for any surgical technique for ACL reconstruction. |
| Advantages |
| Directly measured anatomic placement of femoral tunnel without pitfalls of creating accessory medial portal. |
| Single semitendinosus hamstring harvest. |
| Gracilis preserved as secondary stabilizer or for use as further graft. |
| Cortical fixation at both tibial and femoral sites. |
| Tips and pearls |
| The lateral portal should be placed as close to the patellar tendon as possible to allow easy passage of the translateral instruments. |
| The femoral anatomic midbundle point is halfway along a line from the deep articular margin to the shallow articular margin. This corresponds to the bifurcate ridge. |
| The height of the center of the femoral tunnel is 2 mm plus the radius of the femoral tunnel above the low articular margin. |
| The femoral jig is set at 110°. |
| The tibial jig is set at 70°. |
| The femoral socket is drilled to a depth of 20 mm. |
| The graft is marked 20 mm from the femoral end. When this mark passes beyond the mouth of the socket, the button will have been pulled free of the lateral femoral cortex. |
| Pitfalls and risks |
| It is important to identify and harvest only the semitendinosus. The technique can be performed with a quadrupled gracilis tendon, but graft size is less reliable. |
| In cases of inadequate graft size, a quadrupled semitendinosus and gracilis tendon can be used. This is termed a mega-GraftLink. |
| When one is retrieving the suture loops through the AM portal, they may become looped, making graft passage impossible. To avoid this, one should withdraw 1 end of each of the loops and form a snare at the end of the suture so that they cannot become intertwined. |
| Key points |
| RF ablation of the medial wall of the lateral femoral condyle is vital to preserve the bony landmarks. |
| During femoral preparation, all work is carried out through the lateral portal. All viewing is through the medial portal. |
| The knee is flexed to 90° throughout. |
| Limitations |
| Graft preparation can be more time-consuming than traditional whipstitching. |