Abstract
Purpose: To compare in terms of failure rates, clinical and functional outcomes the all-inside anterior cruciate ligament (ACL) reconstruction with double suspensory fixation and quadrupled semitendinosus autograft with anteromedial portal doubled semitendinosus-gracilis autograft with suspensory femoral and tibial interference screw fixation.Methods: Forty-four patients were sequentially allocated into two groups and followed up prospectively for a 3-year period. The first group was the all-inside group and the second was the “classic” AM portal with S-G graft. Each group comprised 22 patients. All patients underwent KT-1000 testing preoperatively and at a minimum of six months postoperatively. Visual pain analog was recorded preoperatively and during both the immediate postoperative period and throughout the follow-up. The Lysholm knee score was used comparing the preoperative and 24-month timepoints.Results: The visual analog scale (VAS) pain scores showed a significant difference at two weeks (2.4 vs 1.8, p < 0.01 ) in favor of the all-inside group, but that difference disappeared in the later follow-up visits. Similarly, there was no significant difference with Lysholm knee scores at two years and the side-to-side anterior translation measured with the KT-1000. At the three-year mark, there were no failures in either of the groups.Conclusion: The all-inside technique appears to be equivalent in terms of outcomes to the classic S-G technique, and given the less-invasive nature and versatility in graft choices is a safe and effective technique for primary ACL reconstruction.
Highlights
Anterior cruciate ligament (ACL) injury is a common injury, especially among athletic individuals, with ACL reconstructions being well over 100,000 per year in the United States alone [1,2,3,4,5,6,7]
The all-inside technique has been described over 20 years ago and was recently popularized by Lubowich et al [8,9]
The all-inside technique is a relatively new technique that is less invasive compared to classic tendon harvesting and fixation techniques both in terms of donor site harvesting and bony preparation
Summary
Anterior cruciate ligament (ACL) injury is a common injury, especially among athletic individuals, with ACL reconstructions being well over 100,000 per year in the United States alone [1,2,3,4,5,6,7]. In recent years there has been an emerging interest in less invasive techniques and their potential benefits both in terms of morbidity and facility of possible future revision surgery. The technique entails short tunnels and the use of quadrupled semitendinosus graft with dual suspensory fixation. As with all novel techniques, the benefits of reduced donor site morbidity and less invasive nature, have been met with some skepticism, mainly focused on the potential inferiority of the short graft and suspensory fixation both in terms of graft failures and clinical outcome equivalence. The aim of the present study is to compare the all-inside technique with the use of quadrupled semitendinosus graft to the standard tibial tunnel screw fixation with a semitendinosus-gracilis graft in terms of both objective and subjective patient outcomes
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