No Tunnel 2-Socket Technique: All-Inside Anterior Cruciate Ligament Double-Bundle Retroconstruction

This report describes an all-inside, double-bundle anterior cruciate ligament retroconstruction (all-inside ×2 technique), which is a less invasive technique because of the use of sockets (2 femoral and 2 tibial) instead of complete bone tunnels. When performed with allograft, this may be termed a “no-incision” technique. The femoral sockets are reamed via the anteromedial arthroscopic portal. The tibial sockets are created with the all-inside RetroDrill (Arthrex, Naples, FL) from within the joint. The posterolateral bundle graft is passed first and shuttled through the anteromedial portal and fixed on the femur with a RetroButton (Arthrex), interference screw, or both. It is then fixed on the tibia with a bioabsorbable RetroScrew (Arthrex) near full extension. The anteromedial bundle graft is passed through next, and the process is repeated with tibial fixation performed at 45° of flexion. Posterolateral and anteromedial tibial fixation may be backed up by tying over a cortical button.