{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:45:30Z","timestamp":1792075530755,"version":"4.4.0"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Anterior cruciate ligament reconstruction (ACLR) remains a cornerstone of orthopedic sports medicine, yet graft failure rates are high despite advances in surgical techniques. The Modified UKM Internal Bracing (MUIB) technique combines all\u2010inside ACLR with internal suture augmentation, potentially offering enhanced graft protection and improved outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective cohort study evaluated 63 patients who underwent isolated primary all\u2010inside ACLR using the MUIB technique (19 allograft, 44 autograft) between 2020 and 2024. Outcome measures included International Knee Documentation Committee (IKDC) scores, Visual Analog Scale (VAS) pain scores, graft failure rates, Single Leg Hop Test (SLHT) performance, and complication profiles at 3, 6, 12, and 24\u2009months postoperatively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Both allograft and autograft groups demonstrated significant improvement from preoperative to 2\u2010year follow\u2010up (\n p<\/jats:italic>\n \u2009<\u20090.001). There were no statistically significant differences observed between allograft and autograft groups across all outcome measures, suggesting that the MUIB technique may yield comparable outcomes regardless of graft type. Complete pain resolution (VAS 0) was achieved by 6\u2009months in both groups. Notably, no graft re\u2010tears were documented throughout the 2\u2010year follow\u2010up period, with 95.2% of patients achieving SLHT >\u200990% at 12\u2009months. No infections, arthrofibrosis, or hardware\u2010related complications requiring reoperation were recorded.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The MUIB all\u2010inside ACLR technique yielded excellent 2\u2010year outcomes in this cohort, characterized by a zero graft failure rate, complete pain resolution, and exceptional functional recovery. However, given the retrospective, uncontrolled design, these findings should be interpreted as preliminary and hypothesis\u2010generating. Prospective comparative studies are necessary to establish the efficacy and potential superiority of the MUIB technique relative to conventional ACLR approaches.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n 3.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/os.70442","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:01:52Z","timestamp":1792072912000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Excellent 2\u2010Year Outcomes of\n MUIB<\/scp>\n All\u2010Inside\n ACL<\/scp>\n Reconstruction: A Registry\u2010Based Analysis of 63 Patients With Zero Graft Failure"],"prefix":"10.1111","author":[{"given":"Badrul Akmal Hisham Md","family":"Yusoff","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Helmi Bin","family":"Hamid","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norlelawati","family":"Mohamad","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karbela Reza","family":"Ramlan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik Kamarul Arif Nik","family":"Kamaruzman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliff","family":"Omar","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhafir","family":"Asikin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4566-9704","authenticated-orcid":false,"given":"M.","family":"Azwan Aziz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Faculty of Medicine Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.51866\/oa.632","article-title":"Epidemiology of Injuries Among Malaysian Adolescent Karate Athletes: A Cross\u2010Sectional Study","volume":"19","author":"Azwan Aziz M. K. P.","year":"2024","journal-title":"Malaysian Family Physician"},{"issue":"1","key":"e_1_2_13_3_1","doi-asserted-by":"crossref","DOI":"10.3390\/jfmk11010077","article-title":"Anterior Cruciate Ligament Reconstruction Failure: Etiology, Classification, and Revision Strategies\u2010A Narrative Review","volume":"11","author":"Capece G.","year":"2026","journal-title":"Journal of Functional Morphology and Kinesiology"},{"issue":"3","key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"300","DOI":"10.14744\/cpr.2025.76829","article-title":"The Effect of Technical Characteristics of Revision ACL Reconstruction on Functional Outcomes","volume":"47","author":"Kizilkurt T.","year":"2025","journal-title":"Journal of Clinical Practice and Research"},{"issue":"11","key":"e_1_2_13_5_1","first-page":"232","article-title":"Functional Outcomes in ACL Reconstruction: A Randomized Controlled Trial Comparing All\u2010Inside and Transportal Techniques","volume":"14","author":"Sakale H.","year":"2024","journal-title":"Journal of Orthopaedic Case Reports"},{"issue":"1","key":"e_1_2_13_6_1","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-025-98491-1","article-title":"Internal Brace Augmentation in ACL Reconstruction Increases Structural Strength and Stiffness: A Biomechanical Study in a Porcine Tibia Model","volume":"15","author":"Chen S.","year":"2025","journal-title":"Scientific Reports"},{"issue":"2","key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"113","DOI":"10.5704\/MOJ.2607.015","article-title":"Internal Bracing as a Biological \u2018Safety Belt\u2019 in Protected ACL Graft Survival After High\u2010Impact Trauma in Revision Reconstruction: A Case Report","volume":"20","author":"Asim M. J.","year":"2026","journal-title":"Malaysian Orthopaedic Journal"},{"issue":"7","key":"e_1_2_13_8_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0328978","article-title":"Clinical Outcomes of a Novel Single\u2010Stage Cartilage Repair Technique Using Calcified Cartilage Zone Debridement With Hyalofast","volume":"20","author":"Md Yusoff B. A. H.","year":"2025","journal-title":"PLoS One"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.eats.2025.103982","article-title":"Modified Universiti Kebangsaan Malaysia Internal Bracing Graft Preparation Technique Using Allograft for Anterior Cruciate Ligament Reconstruction Surgery","volume":"14","author":"Yusoff B. A. H. M.","year":"2025","journal-title":"Arthroscopy Techniques"},{"issue":"11","key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1016\/j.arthro.2017.06.019","article-title":"Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time","volume":"33","author":"Kaeding C. C.","year":"2017","journal-title":"Arthroscopy"},{"issue":"4","key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"e1513","DOI":"10.1016\/j.asmr.2022.04.008","article-title":"Autograft and Nonirradiated Allograft for Anterior Cruciate Ligament Reconstruction Demonstrate Similar Clinical Outcomes and Graft Failure Rates: An Updated Systematic Review","volume":"4","author":"Dhillon J.","year":"2022","journal-title":"Arthroscopy, Sports Medicine, and Rehabilitation"},{"issue":"8","key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"2799","DOI":"10.1002\/ksa.12537","article-title":"Association of Suture Augmentation With Graft Failure and Clinical Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta\u2010Analysis of Comparative Studies With a Minimum 2\u2010Year Follow\u2010Up","volume":"33","author":"Gao Y.","year":"2025","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"},{"key":"e_1_2_13_13_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.jisako.2026.101081","article-title":"Short\u2010Term Follow\u2010Up of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Quadrupled Hamstring Autograft With Suture Tape Reinforcement as an Internal Brace","volume":"17","author":"Joy V.","year":"2026","journal-title":"Journal of ISAKOS"},{"issue":"4","key":"e_1_2_13_14_1","doi-asserted-by":"crossref","DOI":"10.2106\/JBJS.OA.20.00106","article-title":"Failure Rates of Autograft and Allograft ACL Reconstruction in Patients 19\u2009Years of Age and Younger: A Systematic Review and Meta\u2010Analysis","volume":"5","author":"Cruz A. I.","year":"2020","journal-title":"JBJS Open Access"},{"issue":"1","key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/CORR.0000000000003638","article-title":"All\u2010Inside ACL Reconstruction Offers no Advantage in Clinical Outcomes, Graft Healing, or Tunnel Widening Compared With the Complete Tibial Tunnel Technique: A Prospective Randomized Trial","volume":"484","author":"Okutan A. E.","year":"2026","journal-title":"Clinical Orthopaedics and Related Research"},{"key":"e_1_2_13_16_1","article-title":"All\u2010Inside Anterior Cruciate Ligament Reconstruction Exhibited Superior Functional Outcomes but Increased Knee Laxity to the Traditional Technique in Mid\u2010To\u2010Long Term: A Systematic Review and Meta\u2010Analysis","author":"Zhu Z.","year":"2025","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"},{"issue":"4","key":"e_1_2_13_17_1","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.3390\/jcm15041404","article-title":"All\u2010Inside and Conventional Techniques in Anterior Cruciate Ligament Reconstruction: A Retrospective Comparison Study","volume":"15","author":"Karaali E.","year":"2026","journal-title":"Journal of Clinical Medicine"},{"issue":"12","key":"e_1_2_13_18_1","doi-asserted-by":"crossref","first-page":"3636","DOI":"10.1007\/s00167-018-4916-4","article-title":"Low Rates of Patients Meeting Return to Sport Criteria 9 Months After Anterior Cruciate Ligament Reconstruction: A Prospective Longitudinal Study","volume":"26","author":"Welling W.","year":"2018","journal-title":"Knee Surgery, Sports Traumatology, Arthroscopy"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70442","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.70442","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.70442","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T14:01:54Z","timestamp":1792072914000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.70442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":17,"alternative-id":["10.1111\/os.70442"],"URL":"https:\/\/doi.org\/10.1111\/os.70442","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"2026-07-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"os.70442"}}