Anterior cruciate ligament (ACL) injuries are a common and debilitating issue, particularly for athletes, necessitating a surgical approach that is both effective and minimally invasive. The quest to restore the native stability and function of the knee has led to the development of innovative techniques. This article presents a novel surgical procedure, known as the “Translateral” technique, which offers a refined approach to anatomic ACL reconstruction.
The Evolution of ACL Surgery
Historically, ACL reconstruction techniques have evolved significantly. Early methods often failed to accurately replicate the knee’s complex anatomy, leading to potential issues with knee stability and an increased risk of long-term problems such as osteoarthritis. More recent advancements have focused on “anatomic reconstruction,” which aims to restore the ACL to its native dimensions and insertion sites, thereby improving knee kinematics and function.
The “Translateral” technique is a modern development that builds upon the principles of anatomic reconstruction. It is an “all-inside” procedure, meaning it is performed through small incisions from within the knee joint itself. This approach is designed to minimise surgical trauma, reduce postoperative pain, and shorten recovery times compared to traditional open surgeries.
Key Features of the Translateral Technique
The core of this technique lies in its precise and efficient methodology:
- All-Inside Approach: The procedure uses only two small arthroscopic portals—anterolateral and anteromedial—without the need for an additional accessory portal or excessive knee hyperflexion. All the surgical work is carried out through the lateral portal, while the medial portal is used for viewing.
- Quadrupled Graft: The technique utilises a quadrupled semitendinosus graft, which is harvested from the patient’s own body. This autograft is known for its biomechanical strength, which has been shown to be superior to other graft types and can help ensure long-term knee stability.
- Retrograde Drilling and Sockets: The procedure employs retrograde drilling to create blind-ended femoral and tibial sockets instead of full tunnels. This bone-sparing approach helps to preserve bone stock, an especially important consideration in revision cases. The placement of these sockets is highly precise, using direct measurements to ensure they are created in the native ACL’s anatomic footprint.
- Adjustable Suspensory Fixation: The graft is secured using adjustable suspensory fixation devices at both the femoral and tibial ends. This type of fixation provides a strong, stable construct and allows for a more controlled tensioning of the graft, which is crucial for replicating the natural functional anisometry of the ACL.
By combining these features, the Translateral technique aims to address some of the technical challenges of older methods, such as the vertical femoral tunnel placement associated with transtibial drilling. The result is a highly reproducible procedure that promotes greater rotational stability and better overall patient outcomes.
Professor Wilson’s Comments
“This paper represented my first review and publication of the all-inside ACL reconstruction technique, which I pioneered with Arthrex. I named the approach the Translateral Technique, as all key surgical steps were performed through the lateral portal, in contrast to the conventional medial-based techniques of the time.
Key Innovations
- Translateral Access and Medial Portal Viewing
The technique utilized a lateral working portal with medial portal viewing, providing a direct face-on view of the anatomic femoral footprint. This significantly improved tunnel placement accuracy and allowed for truly anatomic reconstruction.
- Single Hamstring Harvest
We harvested only the semitendinosus tendon, leaving the gracilis intact, resulting in reduced morbidity and better postoperative function. The quadrupled semitendinosus created a larger-diameter graft than the traditional doubled semitendinosus–gracilis construct, offering superior graft strength.
- Retrodrilled Bone-Preserving Sockets
Working closely with the Arthrex engineering team, I designed the first anatomical aimer for the FlipCutter system. This enabled retrodrilled sockets rather than full tunnels, ensuring minimal bone loss, anatomic socket positioning, and bone preservation—a major advance over traditional techniques.
- Suspensory Fixation and Adjustable Tensioning
The graft was fixed using adjustable cortical button devices on both femoral and tibial sides, allowing for precise tensioning and re-tensioning after cycling the knee—optimizing graft isometry and stability.
Historical Significance
In 2011, I performed the first live surgical demonstration of an all-inside ACL reconstruction using this translateral technique at the German Arthroscopic Association (AGA) Meeting in Garmisch.
This was a landmark event, showcasing the future of minimally invasive, anatomic, bone-preserving ACL reconstruction.
Since then, the all-inside translateral technique has become a globally adopted approach, transforming ACL surgery and influencing modern reconstructive strategies.”
For an in-depth review of the complete findings, methodology, and analysis, the original research paper is available for your review:
Anatomic All-Inside Anterior Cruciate Ligament Reconstruction Using the Translateral Technique
Sources used in report overview:
- https://pubmed.ncbi.nlm.nih.gov/23875158/
- https://www.researchgate.net/publication/250926570_Anatomic_All-Inside_Anterior_Cruciate_Ligament_Reconstruction_Using_the_Translateral_Technique
- https://www.arthrex.com/knee/retroconstruction
- https://www.imrpress.com/journal/FBL/27/3/10.31083/j.fbl2703091/htm
