ACL Reconstruction Surgery Techniques

ACL Two-Incision Technique

There are different techniques that can be used during an ACL reconstruction surgery. The ACL two-incision technique is a time-tested method for creating accurate anatomically positioned ACL sockets. However, patients prefer smaller incisions. In the 21st century, new small diameter (3.5 mm) surgical guide pins, which transform into retrograde drills, allow the advantage of two-incision techniques through keyhole size incisions. This “all-inside”, minimally invasive method is Dr. Lubowitz’ preferred surgical technique, and results in equal knee stability outcomes compared to older techniques with evidence-based less pain.

ACL Single-Incision Technique

The ACL single incision, endoscopic or transtibial ACL technique was historically popular, but often results in non-anatomic ACL footprint placement, which is a disadvantage. In addition, in the 21st century, new small diameter (3.5 mm) surgical guide pins, which transform into retrograde drills, allow “all-inside”, least invasive methods which Dr. Lubowitz has pioneered and validated. While Dr. Lubowitz has extensive experience with the single-incision technique, today the “all-inside”, “no-incision”, and “retroconstruction” techniques are the preferred methods, due to evidence-based equal knee stability outcomes, with evidence-based less pain.

ACL No-Incision Technique

The “no-incision” ACL surgery is performed through keyhole size “stabs”, and was pioneered and first published by Dr. Lubowitz in 2006. Using new “retroconstruction” technology, such as small diameter (3.5 mm) surgical guide pins, which transform into retrograde drills, Dr. Lubowitz is able to perform ACL surgery using sockets, instead of full bone tunnels, which results in evidence-based equal knee stability outcomes, with evidence-based less pain. Dr. Lubowitz’ preferred surgical technique is “all-inside” or “no incision” surgery. In truth, the portals do represent small incisions, but the incisions are so small, that the name “no incision” has been published and accepted as the natural progression from two to one to “no” incision surgery.

ACL All-Inside Technique

“All-inside” ACL surgery requires special equipment which allows less invasive surgery, resulting in evidence-based less pain, but critically, evidence-based equal knee stability outcomes. “All-inside” ACL, “no-incision”, “retroconstruction” technique was first reported in the orthopaedic literature by Dr. Lubowitz in 2006, and has since been extensively described, refined, and published by Dr. Lubowitz in the peer-reviewed orthopaedic and arthroscopic medical literature. This technique uses small sockets, instead of traditional full bone tunnels, and by sparing bone, and avoiding large drill tunnels in the tibial cortex (the front of the leg bone), the technique is more cosmetic, with stable graft fixation, and less pain. Dr. Lubowitz’ preferred surgical technique is all-inside surgery.

ACL Double-Bundle Technique

The normal ACL has two anatomic bundles. However, double-bundle surgery may result in “double-trouble”, and double-bundle surgery has not been shown to result in clinically significant improvement in outcome. Usually, Dr. Lubowitz uses the double-bundle concept to achieve anatomic ACL reconstruction, and fill the normal ACL “footprints”, while performing all-inside, anatomic single-bundle technique, which results in less risk of surgical complications. While Dr. Lubowitz does have experience in double-bundle technique, and may offer the double-bundle technique for specific reasons in selected patients on a case-by-case basis, in most cases, Dr. Lubowitz recommends “anatomic”, single-bundle, all-inside ACL surgery.

For more information on ACL reconstruction surgery techniques, please request a consultation with orthopedic knee specialist, Dr. Lubowitz, by clicking the link below.