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

All-inside double-bundle anterior cruciate ligament (ACL) reconstruction is a technique that requires attention to the details of several steps. The technique is based on performing the steps of all-inside ACL reconstruction first for the posterolateral ACL bundle and then again for the anteromedial bundle. Thus, the technique may be considered as the all-inside × 2 technique. Double-bundle ACL reconstruction more closely reproduces the normal 2-bundle anatomy of the ACL. All-inside × 2 double-bundle ACL reconstruction allows for independent anteromedial and posterolateral bundle tensioning to mimic normal ACL biomechanics. In addition, all-inside × 2 is a minimally invasive modification of ACL reconstruction in which full-graft bone tunnels are eliminated in favor of sockets on both the femoral and tibial sides. Thus, all-inside × 2 results in a potential for less patient pain, improved cosmesis, and faster recovery. This article describes in detail the all-inside × 2 ACL reconstruction technique.