Abstract
PurposeThe aim of this study was to define the subjective and objective clinical results of all-inside surgical technique at a medium-term follow-up and to compare these results with those obtained from antero-medial (AM) ACL reconstruction technique using hamstrings (HS) or bone-patellar tendon-bone (BpTB) grafts to detect eventual superiority of one technique to another.MethodsA retrospective analysis of routinely collected data was conducted. Inclusion criteria were ACL reconstruction through all-inside technique or AM technique with HS or BpTB performed between January 2015 and May 2018; age between 15 and 30 year old; minimum 24 months’ available follow-up. Exclusion criteria were contralateral ACL reconstruction; need for any other associated procedures during surgery. Clinical outcomes were assessed with KOOS, Lysholm, Tegner scores and KT-1000 device.ResultsAccording to the selection criteria, 157 patients were enrolled and divided subsequently into 3 groups: all-inside (51 patients), AM-HS (53 patients) and AM-BpTB (53 patients). A significant postoperative improvement of each score in all groups was detected. The mean KT-1000 was 3.1 ± 1.0 mm in all-inside group, while 3.3 ± 1.4 mm and 2.5 ± 0.4 mm in AM-HS and AM-BpTB groups, respectively. Comparing the results obtained, no statistically significant difference was found between the three techniques (p = 0.27). Statistically significant differences were highlighted in surgical duration: all-inside method was the longest (117′), followed by AM-BpTB surgery (101′) and AM-HS technique (87′).ConclusionsThe all-inside technique showed good postoperative results at medium-term follow-up. It could be a valuable solution for ACL reconstruction, especially in young patients due to its less invasiveness, despite surgical skills and time needed.Levels of evidenceLevel IV.
Highlights
Anterior cruciate ligament (ACL) surgical reconstruction dates back to the late nineteenth century when Dr Robson performed the first successful ACL repair on a 41-year’s old coal miner [1, 2]
According to the inclusion and exclusion criteria, 157 patients were enrolled: 51 patients operated with all-inside method; 53 patients treated with the AM method using hamstrings autograft; 53 patients operated with the AM technique using bone-patellar tendon-bone autograft
The cause of ACL disruption was evaluated for each patient (Fig. 1): 91.7% were due to sport-trauma, mainly soccer (53.6%), followed by skiing, volleyball and basketball (8.2% for each sport)
Summary
Anterior cruciate ligament (ACL) surgical reconstruction dates back to the late nineteenth century when Dr Robson performed the first successful ACL repair on a 41-year’s old coal miner [1, 2]. The technique was further modified and optimized in order to overcome the open procedure making the reconstruction less invasive, lowering complications, intra-operative bleeding and postoperative pain to provide quick recovery [3]. Following and implementing these principles, the all-inside reconstruction technique was conceived [4, 5]. The all-inside technique for ACL reconstruction [5], compared to the traditional Antero-Medial (AM) or Transtibial methods, features substantial improvements including two closed-socket tunnels, double (femoral and tibial) suspensory fixation and smaller skin incisions [6]. That allows the graft insertion to be performed through an arthroscopic portal, minimizing postoperative bleeding, soft tissue damage and especially bone loss (reduction from 54 to 64%) and postoperative pain [7,8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
