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 X2 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 degrees of flexion. Posterolateral and anteromedial tibial fixation may be backed up by tying over a cortical button.