Clinical outcomes using translateral all-inside ACL reconstruction

Abstract

Introduction Current practices in anterior cruciate ligament (ACL) reconstruction fail to restore normal knee kinematics. In vitro studies demonstrate biomechanical advantages of anatomic positioning in single bundle reconstructions over traditional techniques. We present the clinical outcomes in a series of 237 patients, mean age 32.2 years (range 10–74) who underwent anatomic all-inside ACL reconstruction, using the translateral surgical technique. Methods The semitendinosus alone is harvested, quadrupled and attached in series to two adjustable suspensory cortical fixation devices. Anatomic placement on the femur is achieved using the validated direct measurement technique. Femoral and tibial sockets are created with a retrograde drill. Patients were evaluated preoperatively and at 6, 12 and 24 months postoperatively using the KOOS, Tegner and Lysholm scoring indices. Knee laxity was assessed using KT-1000 along with goniometric measurement of range or motion. Results Overall complication rate 8.4% (20 cases). There were 9 graft failures (3.8%) – 6 due to significant postoperative trauma. Other complications include 5 superficial wound infections treated with oral antibiotics, 2 haemarthroses, 3 knees with postoperative stiffness requiring manipulation and 1 patient who developed chronic regional pain syndrome. Mean increase at 1 year in KOOS, 26.3 points; Tegner, 1.4 levels; and Lysholm, 30.4 points. Mean range of movement at 12 months, 1o hyperextension to 137o flexion. KT-1000 improved to 3.1 mm side-to-side difference.