Current and future of anterior cruciate ligament reconstruction techniques

Table 1 Characteristics of various autograft materials

	Hamstrings	BTB	Quadriceps
Cross-sectional area	Good to excellent	Fair to good	Good to excellent
Mechanical strength	Good	Good to excellent	Excellent
Adjustment of graft length	Possible	Difficult	Easy
All-inside technology	Easy	Sometimes difficult	Easy
Preservation of remnant	Possible	Sometimes difficult	Sometimes difficult
Double bundle	Easy	Difficult	Possible
Graft fixation
Femoral	Cortical button	Interference screw	Interference screw
		(metalic > bioabsorbable)	(metalic > bioabsorbable)
		Cortical button	Cortical button
Tibial	Cortical button	Interference screw	Cortical button
	Interference screw	(metallic ≥ bioabsorbable)	Interference screw
	(metalic < bioabsorbable)
	Post fixation
Complication	Nerve injury	Patellar fracture	Patellar fracture
	(infra-patellar branches of the saphenous nerve)
	Decrease of Flexor muscle strength	Kneeling pain
		Anterior knee pain
		Decrease of extensor muscle strength	Decrease of extensor muscle strength
Indication
Recommend	Amateur athlete	Amateur and professional athlete	Amateur and professional athlete
		(high-intensity sports)	(high-intensity sports)
			Revision surgery
Not recommend	Ballet dancer	Wrestler, Judo, Karate

BTB: Bone–patellar tendon–bone.

Table 2 Features of independent and dependent techniques

	Independent technique		Dependent technique
	Anteromedial	Outside-in	TT	Modified TT	TT with modified devices
Femoral tunnel position	Anatomical	Anatomical	Somewhat unanatomical	Anatomical	Anatomical
Complexity of technique	Relatively simple	Somewhat complicated	Simple	Simple	Simple

TT: Transtibial.

Table 3 Features of the conventional technique and all-inside technique

	Conventional technique	All-inside technique
Invasiveness in the tibial tunnel
Bone damage	Moderate	Minor
Bleeding	Moderate	Minor
Invasiveness during autograft harvesting	Minor or moderate	Minor
Postoperative pain	Moderate	Minor
Complexity of surgery	Minor	Moderate