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All-Inside ACL Reconstruction Vs. Traditional ACL Reconstruction Featuring Auxein’s Graft Fixation System

ACL Anatomy & Mechanism of Injury

The anterior cruciate ligament (ACL) is one of the four key stabilizing ligaments of the knee. It runs from the lateral femoral condyle to the anterior tibial plateau. Functionally, it prevents anterior tibial translation, controls rotational loads, and contributes to proprioception.

ACL injuries are common in athletes, especially during pivoting, sudden deceleration, or improper landings. About 70% are non-contact injuries, often occurring in sports like basketball, football, and skiing.

Sherman Classification of ACL Tears

  • Type I: Proximal avulsion tear with minimal distal remnant (ligament detached close to femoral insertion, <25% intact).
  • Type II: Proximal tear with 25–50% of ligament still attached to femur.
  • Type III: Tear at the midsubstance of the ACL (mid-ligament rupture).
  • Type IV: Distal avulsion tear near tibial insertion (ligament detached close to tibial attachment).
The Sherman Classification of ACL Tears

Surgical Technique Overview

The primary differences between the two procedures lie in their approach to bone and tissue preservation.

  • Traditional ACL Reconstruction: This method involves drilling full tunnels through both the femur and tibia to pass the graft. It typically requires harvesting both the semitendinosus and gracilis tendons, leading to greater donor site morbidity. The procedure also necessitates larger incisions.
  • All-Inside ACL Reconstruction: This modern technique is significantly less invasive. Surgeons create short, bone-preserving sockets instead of full tunnels. It often requires only the semitendinosus tendon, reducing soft tissue damage and donor site morbidity. The use of Auxein’s GFS facilitates this through smaller, minimally invasive incisions.

Feature

Traditional ACL Reconstruction

All-Inside ACL Reconstruction (Auxein’s Graft Fixation System)

Bone Drilling

Full tunnels through femur & tibia

Short sockets, bone-preserving

Graft Harvest

Semitendinosus + gracilis or patellar tendon

Semitendinosus only → less donor site morbidity

Incision Size

Larger incisions

Smaller, minimally invasive

Clinical Outcomes Comparison

Outcome

Traditional ACL Reconstruction

All-Inside ACL (GFS System)

Postoperative Pain (VAS)

7.5 (week 1)

4.2 (week 1)

Recovery Time

Return to sports: 9–12 months

Return to sports: 7–9 months

Knee Stability

Excellent

Comparable or superior

Complication Rate

Moderate (tunnel widening risk)

Lower (better graft integration)

Patient Satisfaction

High

Higher (less pain, faster rehab)

Advantages of Auxein’s Graft Fixation System

  • Strong dual suspensory fixation
  • Bone preservation → less tunnel expansion, easier revisions
  • Enhanced graft-bone healing
  • Surgical efficiency → shorter operative time
  • Patient benefits: less pain, faster recovery, higher satisfaction

Recovery Timeline Comparison

Milestone

Traditional ACL

All-Inside ACL (GFS System)

Return to light activity

8 weeks

5 weeks

Return to sports

9–12 months

7–9 months

Full knee function

12 months

9–10 months

Why Choose All-Inside ACL with Auxein’s Graft Fixation System?

  • Minimally invasive with less pain and swelling
  • Preserves bone and soft tissue for better long-term joint health
  • Faster rehabilitation and earlier return to sports
  • Supported by robust biomechanical and clinical studies

 

References

  1. Monaco, E., et al. (2019). All-inside vs complete tibial tunnel for ACL reconstruction: clinical outcomes at 5-year follow-up. Am J Sports Med, 47(3), 695–704. doi:10.1177/0363546518820304
  2. Lubowitz, J. H., et al. (2019). All-inside ACL reconstruction and graft fixation: a review. Arthroscopy, 35(6), 1889–1898.
  3. Alentorn-Geli, E., et al. (2018). Return to sport after ACL reconstruction: traditional vs all-inside. Knee Surg Sports Traumatol Arthrosc, 26(8), 2343–2351.
  4. Cristiani, R., et al. (2020). Superior patient-reported outcomes after all-inside ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 28(2), 486–494.
  5. Smith, P. A., et al. (2018). Biomechanical comparison of graft fixation in all-inside vs full tunnel ACL reconstruction. Orthop J Sports Med, 6(2), 232596711875530.
  6. Zaffagnini, S., et al. (2019). Clinical stability and tunnel widening in all-inside ACL. J Bone Joint Surg Am, 101(20), 1855–1864.
  7. De Sa, D., et al. (2018). Systematic review of all-inside ACL reconstruction. Arthroscopy, 34(4), 1316–1333.
  8. Xu, M., et al. (2021). Meta-analysis: all-inside vs conventional ACL reconstruction. J Orthop Surg Res, 16(1), 102.
  9. Moatshe, G., et al. (2020). Long-term graft survival: all-inside vs traditional techniques. Am J Sports Med, 48(9), 2242–2251.
  10. Song, G. Y., et al. (2017). Tunnel widening and graft healing after all-inside ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 25(8), 2429–2437.

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