Area of Focus: Arthroscopy and Sports Medicine

This video presentation demonstrates a simple method for performing a single-bundle ACL reconstruction with a four-strand hamstring autograft utilizing bone sockets. After creating femoral and tibial sockets, the folded end of the graft is fixed in the femur. The four free limbs are then passed into the tibial socket. Next, an interference screw is passed and placed inside the joint at the level of the tibial plateau. Secondary fixation using the intact tibial cortex is recommended. ACL reconstruction utilizing bone sockets offers several advantages over standard transtibial techniques. First, it allows drilling of the femoral and tibial sockets from inside the joint. The drilling devices can be placed anatomically, and socket location can be visualized independent of portals and tunnels. The drilling begins in a retrograde fashion that avoids bone fragmentation at the socket orifice. This enhances aperture fixation of the graft. By creating sockets instead of tunnels, the femoral and tibial cortices remain intact. This is useful in providing stable secondary fixation and decreasing the morbidity associated with periosteal disruption. Finally, performing the entire procedure from the inside can enhance cosmesis and patient satisfaction. The video also covers indications, advantages, key points of the procedure, and post-operative protocols.