{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T17:01:13Z","timestamp":1782406873699,"version":"3.54.5"},"reference-count":24,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There are limited comparisons of graft configurations and fixation methods for the all\u2010inside anterior cruciate ligament (ACL) technique based on a laboratory investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose\/Hypothesis:<\/jats:title>\n                    <jats:p>This review aimed to evaluate the biomechanical data from controlled laboratory studies on different graft configurations and fixation methods in correlation to graft strength and stability in all\u2010inside ACL reconstruction. It was hypothesized that graft configuration and supplementary fixation would significantly contribute to graft strength and stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Scoping review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A literature search was conducted via PubMed on January 15, 2025, including studies that examined all\u2010inside ACL graft techniques in a controlled biomechanical manner; reported data on stiffness and\/or ultimate load to failure, and utilized cadaveric, porcine, or bovine tendons with cyclic loading and pull\u2010to\u2010failure testing protocols. A total of 150 studies were shortlisted before being narrowed down to 11 biomechanical studies, with descriptive statistical analysis performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>This review demonstrated that quadrupled ACL grafts outperformed tripled grafts in stiffness and load to failure. Adjustable-loop devices provided robust primary fixation, while supplementary fixation further enhanced graft stability. Overall, 3 failure modes emerged: graft failure, fixation failure, and suture failure, directly linked to surgical technique choices. Findings established evidence\u2010based benchmarks for optimizing all\u2010inside ACL reconstruction outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our search and review demonstrated that a quadruple\u2010folded graft with the side\u2010to\u2010side suturing technique, suspended by 2 adjustable\u2010loop devices with additional tensioning and knot tying, and supplementary fixation with tibial reinforcement appears to offer the most stability. This has the potential to optimize functional recovery after ACL reconstruction via improved graft stability and reduced rerupture rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671251363592","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T14:54:01Z","timestamp":1755788041000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Biomechanical Properties of the All-Inside Anterior Cruciate Ligament Graft: A Scoping Review of Laboratory Evidence on Graft Configuration and Fixation"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3536-9145","authenticated-orcid":false,"given":"Amirzeb","family":"Aurangzeb","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sir Young James","family":"Loh","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Changi General Hospital, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-2123-y"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671231201461"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.10.130"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967120938039"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-011-1653-3"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jor.2017.03.002"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/03635465000280010801"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eats.2023.06.017"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671211006521"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2024.106384"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-023-03613-y"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-015-3605-9"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.08.283"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.04.014"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.02.010"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2017.02.010"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-012-2085-4"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2018.11.065"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-38150-w"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40634-018-0158-0"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/23259671221091252"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659702500222"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/036354659101900303"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2019.06.007"}],"container-title":["Orthopaedic Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671251363592","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259671251363592","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259671251363592","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:29:06Z","timestamp":1777595346000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259671251363592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":24,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1177\/23259671251363592"],"URL":"https:\/\/doi.org\/10.1177\/23259671251363592","relation":{},"ISSN":["2325-9671","2325-9671"],"issn-type":[{"value":"2325-9671","type":"print"},{"value":"2325-9671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"article-number":"23259671251363592"}}