All-inside Technique Research Articles

Arthroscopic all-inside wrapping repair of lateral meniscus bucket-handle tears: clinical and imaging outcomes

PurposeThis study aimed to assess the clinical and radiographic healing rates of the arthroscopic all-inside wrapping repair technique for lateral meniscus bucket-handle tears (LMBHTs).MethodsThis retrospective study examined patients diagnosed with LMBHTs who underwent all-inside wrapping repair with or without anterior cruciate reconstruction between 2012 and 2021. Patients with previous knee surgeries, multiligamentous knee injuries, or advanced osteoarthritis were excluded. Clinical follow-up was at least 2 years. Clinical healing was defined as no reoperation of LMBHTs following initial repair and the absence of symptoms related to the LMBHT during follow-up. Postoperative clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score. At 6 months postoperatively, the healing of the repaired meniscus was evaluated using Henning’s criteria through magnetic resonance imaging (MRI).ResultsOf the 34 patients included, two required re-operation for a re-tear of the BHT, resulting in a clinical healing rate of 94.1% (95% confidence interval [CI]: 82.9–99.2%) at a mean follow-up of 4.2 years. Among the remaining 32 patients, the mean postoperative IKDC score was 83.7 ± 8.2 (range, 70–95). MRI evaluations at 6 months postoperatively revealed complete healing in 64.7% (22/34; 95% CI: 47.9–79.5%), partial healing in 23.5% (8/34), and failure to heal in 12.5% (4/34, including the two re-tear cases). Subgroup analyses indicated no significant difference in the IKDC scores between patients with complete healing and those with partial healing on MRI (85.5 ± 7.9 vs. 82.3 ± 8.5; p = 0.53). Future studies with larger cohorts and stratified analyses are needed to explore potential predictors of healing outcomes.ConclusionsThe all-inside wrapping repair technique demonstrated favorable outcomes in patients with lateral BHTs and can be used as a viable alternative.

All-Inside Versus Conventional Technique in Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

All-Inside Versus Conventional Technique in Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial

Biomechanical comparison of different surgical suture techniques for four-stranded all-inside cruciate ligament grafts

BackgroundAll-inside cruciate ligament reconstruction is an emerging technique for treating anterior cruciate ligament and posterior cruciate ligament injuries. The all-inside technique uses a 4-stranded graft made of a single tendon that wraps around itself. Four strands of the graft must be immobilized to form a closed loop, and the free ends of the graft must be attached using a suture technique. There is currently no “optimal” or “standard” suture technique for attaching the free ends of grafts. MethodsTwenty porcine flexor tendons retrieved from hind limbs were prepared for quadrupled-strand grafts using four different methods:1. using the whipstitch technique and a new suture technique with a side-to-side graft configuration (w-s graft, new SS graft), 2. using the Krackow suture technique and Kessler suture technique with an end-to-end graft configuration (Krackow graft, Kessler graft). Followed by tensile testing (including preconditioning). FindingAmong the tested techniques, the quadrupled-strand grafts formed with the new suture technique performed best in terms of ultimate failure load (931.03 ± 20.53 N) and stiffness (236.85 ± 9.73 mm), with a statistically significant difference between side-to-side grafts and end-to-end grafts in terms of ultimate failure load in both groups. The new side-to-side graft (5.30 min) showed the shortest graft preparation time. InterpretationThere is no doubt that the new suture technique described here has higher tensile and breaking forces than other four-strand suture techniques and is superior to other technologies in terms of preparation time, and side-to-side grafts performed better biomechanically than the end-to-end graft configuration.

Evaluating knee function post-ACL reconstruction: conventional versus all-inside technique using Lysholm score

Anterior cruciate ligament (ACL) reconstruction is a common surgical intervention. The aim of this paper was to make a comparison in terms of subjective symptoms that occur in a specific Lysholm scoring scale-in-progress before the operative period, 3 and 8 months after surgical treatment with two surgical methods. Materials and Methods: Eighty patients underwent primary ACL reconstruction at the Department of Orthopaedics and Traumatology in the City General Hospital “8th September” in Skopje in a period of two years. The first group (40 subjects) constituted the control group (CG), surgically treated with a standard method using a graft from m. semitendinosus and m. gracilis. The second group (40 subjects) was the study group (SG) surgically treated with the ALL-INSIDE method using a m. semitendinosus graft. In all subjects preoperatively, at 3 and 8 months after surgical treatment, Lysholm scale was completed representing a designed questionnaire for evaluation of subjective symptoms. Results: Preoperatively, most patients from SG had a score lower than 65 to 55 % (22), while in CG between 65 and 83 – 50% (20). After 3 months of surgical treatment, SG patients had averagely a higher score than CG patients (88.60 ± 11.8 vs. 85.75 ± 17.8), but without statistical significance. Among SG and CG patients, 8 months after surgery (p = 0.043), SG patients had a significantly higher mean score than CG patients (97.62 ± 5.3 vs. 92.40 ± 15.1). Lysholm scale analysed qualitatively 8 months after surgical treatment showed no significant difference between them, i.e., the tested difference in the distribution of patients with a score of less than 65, from 65 to 83, from 84 to 90 and more than 90, and depending on the type of the surgical method was statistically insignificant (p = 0.123). Conclusion: The type of surgical technique used had no significant influence on the subjective complaints of patients after 3 months of surgical treatment. But after 8 months, a better functional result was obtained in SG patients

Long-term Comparative Outcomes of All-Inside Versus Inside-Out Repair of Bucket-Handle Meniscal Tears: A Cohort Study.

Bucket-handle meniscal tears (BHMTs) are a common subtype of meniscal tears that represent a clinical challenge. Arthroscopic inside-out repair has been considered the gold standard in treatment; however, an all-inside approach has gained widespread popularity, with limited long-term evidence. The purpose of this study was to (1) compare long-term clinical outcomes and rates of failure after surgical repair of BHMTs using the all-inside versus inside-out technique, and 2) identify risk factors for failure at long-term follow-up. It was hypothesized that clinical outcomes and rates of failure would be similar between the 2 techniques. Cohort study; Level of evidence, 3. Patients who had undergone surgical repair of BHMTs between 2003 and 2013 at a single institution were identified. Patient-reported outcome measures (PROMs) were assessed preoperatively and at the latest follow-up using the Tegner scale, International Knee Documentation Committee questionnaire, and visual analog scale pain at rest and with activity. A univariate Cox proportional hazards model was used to identify predictors for repair failure, defined as revision meniscal surgery and/or documented meniscal retear. In total, 63 patients were included (37 with inside-out repair, 26 with all-inside repair). At a mean follow-up of 11.2 years, the survival rate for BHMT repair was 63% overall, 70% for all-inside repairs, and 60% for inside-out repairs (P = .37). The mean time to failure was 2.6 years for all-inside repairs and 2.5 years for inside-out repairs (P = .98). PROM scores were not significantly different between the 2 repair groups (P > .22). Univariate Cox proportional hazards model for failure demonstrated that increasing age at surgery was associated with lower failure rates (hazard ratio, 0.91 change per 1-year increase in age; 95% CI, 0.84-0.98) and medial meniscus repair was associated with higher failure rates (hazard ratio, 3.12; 95% CI, 1.14-8.77). Long-term follow-up of BHMT repair demonstrated satisfactory clinical outcomes and failure rates. In appropriately selected patients, the all-inside technique did not compromise outcome as compared with the inside-out repair techniques. For both methods, older age was associated with lower failure rates and medial meniscus repair was associated with increased failure.

Comparison of the effects between arthroscopic transtibial pullout technique and all-inside repair in the treatment of medial meniscus posterior root tears.

Medial meniscus posterior root tears (MMPRTs) significantly contribute to knee dysfunction, leading to abnormal biomechanics and accelerated cartilage degeneration. Arthroscopic transtibial pullout and all-inside repair are two commonly used techniques for treating MMPRTs, each with unique advantages and limitations. To compare the clinical and functional outcomes of the transtibial pullout and all-inside repair techniques in the treatment of MMPRTs, with a focus on postoperative recovery, knee function, and complications. 40 patients with MMPRTs were randomized to undergo either the transtibial pullout or all-inside repair technique. Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) score, Tegner activity scale, Lysholm score, and active range of motion (AROM) of knee flexion, both before and after surgery. Data on operative time, time to ambulation, hospital stay duration, and complications were also collected. Both surgical groups showed significant improvements in clinical outcomes postoperatively (p<0.001). The transtibial group exhibited greater functional recovery, with IKDC, Tegner, and Lysholm scores improving by approximately 60%, 110%, and 68%, respectively, compared to the all-inside group. However, complications were more frequent in the transtibial group, including three cases of wound healing issues and one infection, while the all-inside group had one case of deep vein thrombosis. No re-tears were observed in either group during follow-up. Both the transtibial pullout and all-inside repair techniques effectively restore knee function in patients with MMPRTs. While the transtibial pullout provides better functional outcomes, it is associated with a higher complication rate. The choice of surgical approach should consider patient-specific factors, including tear characteristics and overall health, to optimize results.

Arthroscopic repair is an effective treatment for dynamic medial ankle instability secondary to posttraumatic and partial injury of the deltoid ligament deep fascicle.

When the intermediate or collicular fascicle of the medial collateral ligament (MCL) is injured, the diagnosis of posttraumatic medial ankle instability (MAI) is supported. The aim of this study was to describe an arthroscopic all-inside MCL repair after posttraumatic MAI secondary to an isolated injury of the MCL deep fascicle with a knotless suture anchor technique. Seven patients (seven men, median age: 23 [19-28] years) with posttraumatic MAI were treated by arthroscopic means after failing nonoperative management. The median follow-up was 34 (13-75) months. The MCL was repaired with an arthroscopic all-inside technique. A tear affecting the deep and intermediate or collicular fascicle of the MCL was observed in all cases. In addition, five patients were diagnosed with an isolated fibular anterior talofibular ligament (ATFL) detachment, and in two patients, both the ATFL and calcaneofibular ligament were involved. All patients reported subjective improvement after the arthroscopic ligament repair. The median American Orthopedic Foot and Ankle Society score increased from 68 (range: 64-70) preoperatively to 100 (range: 90-100) at final follow-up. Posttraumatic MAI can be successfully treated by an arthroscopic all-inside repair of the MCL. The presence of an MCL tear affecting the tibiotalar ligament fibres attached to the area of the anterior colliculus should be considered a sign of posttraumatic MAI. This partial deltoid injury at the level of the intermediate or collicular fascicle will conduct to a dynamic MAI. Level IV.

Functional Outcomes in ACL Reconstruction: A Randomized Controlled Trial Comparing All-Inside and Transportal Techniques.

The two techniques to fix a torn ACL are the Transportal and All-Inside Techniques. However, the argument about which method is better for functional outcomes keeps going on. The aim was to look at how well these two treatments worked and their effects. We hypothesized that All-Inside and Transportal ACL reconstruction procedures would yield similar functional results. The study included 45 patients with ACL insufficiency from AIIMS, Raipur, India. Half of each ACL approach was represented by 22 AI and 23 TP participants, randomly assigned to each group. Preoperative and post-operative VAS, IKDC, and range of motion were determined at 1, 3, and 6 months. The study used IBM SPSS v20 for Data Analysis, comparing two groups using a t-test. P < 0.05 was fixed for Statistical significance. The study was dominated by young males (86.7%, 18-30 years), mainly students (44.4%). Comparable IKDC scores over time (P = 0.628); significant VAS score difference (P = 0.001). A similar movement range (P = 0.153) was observed. AI group had slightly smaller grafts (non-significant, P = 0.235). Similar Lachmann Grade distributions pre- and post-surgery; no significant post-operative complication in either group. When comparing the methods' functionalities, no statistically significant gaps emerged. All-Inside approach preserves bone and gracilis tendon, reduces post-operative pain, and strengthens knee flexors. Although, early rehabilitation favors all inside, both methods are equally effective over time. In comparison to the traditional Transportal Technique, All Inside has a greater learning curve and costs more.

Meniscal Radial Tears Repaired with All-Inside and Inside-Out Techniques Result in Improved Clinical Outcome Scores; However, More Complications are Reported After Inside-Out Repair: A Systematic Review

Objectives To compare patient-reported outcomes (PROs), failure, and healing rates following all-inside (AI) repair versus inside-out (IO) repair for the treatment of meniscal radial tears. Methods A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Scopus, PubMed, and Embase computerized databases. Level of evidence I through IV human clinical studies evaluating PROs and/or the incidence of failure and healing following AI versus IO repairs for meniscal radial tears were included. Study quality was assessed using the MINORS criteria and MCMS score. Results Ten studies comprising 205 patients were identified including 142 patients who underwent AI repair and 63 patients who underwent IO radial repair. Postoperative Lysholm and Tegner scores ranged from 90.8 to 95.6 and 5.7 to 8.2, respectively, in the AI repair group, compared to 86.9 to 94.2 and 6 to 7.5, respectively, in the IO repair group. Clinical failure ranged from 0% to 21.4% % and 0% to 62.5% in the AI and IO groups, respectively. Healing assessments on second-look arthroscopy revealed failure rates ranging from 0% to 8% in the AI repair group and 0% to 30% in the IO group. Complete and partial healing ranged from 13% to 69% in the AI group and from 22% to 58.3% in the IO group. Postoperative complications ranged from 0%-2% within the AI group compared to the IO group ranging from 0% to 25%. No implant-related complications were reported in any study group. Conclusion All-inside and inside-out repairs for meniscal radial tears both demonstrate improved PROs; however, current literature suggests that the IO technique may present higher failure and complication rates relative to AI repair techniques.

Comparison of a full tibial tunnel or an all-inside technique for anterior cruciate ligament reconstruction: An observational study.

This study aims to compare the effectiveness of anterior cruciate ligament (ACL) reconstruction performed with either a full tibial tunnel technique or an all-inside technique. Data from patients with ACL rupture who underwent ACL reconstruction using autogenous hamstring tendon grafts between January 2019 and July 2021 were retrospectively reviewed. Patients were followed up for a minimum of 24 months. Preoperative and postoperative International Knee Documentation Committee scores, Lysholm knee scores, visual analog scale pain scores, Tegner activity scale scores, C-reactive protein levels, erythrocyte sedimentation rate, white blood cell (WBC) count, D-dimer levels, and neutrophils were recorded. At the final follow-up, side-to-side differences were assessed with the pivot shift test, Lachman test, anterior drawer test, and a knee laxity-testing device. This study included 135 patients with ACL rupture, with 62 patients (43 males and 19 females, mean age: 34.42 ± 12.79 years) undergoing the full tibial tunnel technique, and 73 patients (58 males and 15 females, mean age: 32.41 ± 11.01 years) undergoing the all-inside techniques (AITs). There were no significant differences in postoperative International Knee Documentation Committee scores, Lysholm knee scores, or Tegner activity scale scores, except at postoperative 6 months. visual analog scale pain scores showed significant improvement in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 week, 2 weeks, and 1 month; however, there were no significant differences at postoperative 3, 6, 12, 18, and 24 months. C-reactive protein levels, erythrocyte sedimentation rate, WBC count, D-dimer levels, and neutrophils were significantly lower in patients that underwent the AIT compared to the full tibial tunnel technique at postoperative 1 month, but there were no other significant differences in these outcome measures, except for WBC count at postoperative 3 months. There was no significant difference in knee stability at the last follow-up. In ACL reconstruction, functional outcomes following the AIT are satisfactory and similar to the total tibial tunnel technique, but patients experience less pain and a reduced early postoperative inflammatory response. These results highlight the promising potential of AITs in the clinical management of ACL rupture and advocate for their widespread adoption.

Clinical and Radiological Outcomes after Radial Tear Repair of the Meniscus

Abstract Background Radial meniscal tears cut through the longitudinal collagen bundles that extend from the free edge to the periphery, running perpendicular to the meniscal axis and tibial plateau. They, by default, contains an element extending to white-white and red-white zones. This is why they were once considered a non repairable tear and not capable of healing and they were usually menisectomized. Radial tears were found in 15% of patients with meniscal tears. Additionally, they were detected in 7% of arthroscopy-detected meniscal tears in patients with a preoperative diagnosis of knee OA and/or chronic meniscal tears. They are equivalent to total meniscectomy in terms of increasing focal contact pressure and excessive stress concentration and meniscal extrusion. Moreover, we know that the peripheral 1/3 of a meniscus has a blood supply adequate enough to bring healing nutrients to the area of the tear. Therefore, it was always assumed that only tears within the outer 1/3 of a meniscus would heal once they are repaired. Recent research has shown that tears with little blood supply are still capable of healing after they have been sutured. Methods From September 2020 to March 2023, we performed a prospective case series on 15 patients reviewed in our institutions hospital by history taking, trauma mode, clinical examination, magnetic resonance imaging, and subjective scores (Lysholm and International Knee Documentation Committee (IKDC)) to describe the functional and radiological outcome of radial meniscal tear repair with two horizontal suture configurations. All selected 15 patients had radial meniscal tears, with a mean time between injury and surgery is 2 month. All patients met the inclusion criteria, all cases are evaluated clinically and by the same examiner. The mean duration of follow up was 19.5 months(ranging from 18 to 28 months). Full history and clinical examination was done for all patients, followed by X-rays and MRI if needed. All patients were assessed regarding pain, ROM, IKDC, Lysholm, score and radiological outcomes. Postoperative complications were recorded. The evaluation was done preoperatively and each time of follow up with a minimum period of 18 months. Results Our study included 15 patients with radial meniscal tears who underwent arthroscopic repair either with outside in or all-inside technique. Our results showed improved clinical scores of the repair either with medial or lateral menisci. No differences were found in results with concomitant ACL tears or the use of fibrin clots. Also, different repair techniques did not show significant difference in functional outcomes. All patients had significant improvement in functional outcomes. Functional outcomes included functional scores and ROM. Regarding functional scores, we assessed IKDC and lysholm score prior to surgery, 6 months and 18 months following surgery. At 18 months follow up, we found significant improvement in all patients in both IKDC and lysholm score (p value of 0.025 and 0.023 respectively) and the mean difference of both sores measured 41.8 and 36.1 respectively. Most of the patients showed most of the improvement in IKDC and Lysholm scores at the first 6 months (mean difference between 0 and 6 months 40.92 and 34.2 respectively). Also, ROM and Joint line tenderness improved for 14 patients at 6 months postoperative. There was 1 patient who was 31 years old and had PHMM injury that was repaired using all-inside technique but showed persistent knee pain and limited ROM. MRI was done and it showed high signal intensity at the site of injury with no signs of healing. Therefore, we re-operated this patient after 7 months and his second look arthroscopy revealed no signs of healing and menisectomy was done. At 18 months follow up, ROM and JLT were improved. Conclusion Patients underwent arthroscopic repair of radial meniscal tears showed good short term functional outcomes. Being able to return to their previous level of activity with preservation of the meniscus.

Outcomes According to Remnant Ligament Tissue Quality after Arthroscopic All-Inside Anterior Talofibular Ligament Repair for Chronic Ankle Instability

Category: Sports; Arthroscopy Introduction/Purpose: Arthroscopic all-inside techniques have gained prominence in the treatment of chronic ankle instability (CAI), offering effective solutions. However, arthroscopic treatment of CAI with poor remnant ligament-tissue quality is still controversy. This study aims to evaluate the outcomes of the arthroscopic all-inside anterior talofibular ligament (ATFL) repair, according to the quality of remnant ligament. Methods: A retrospective analysis was conducted on consecutive CAI patients who underwent arthroscopic ATFL repair, with a follow-up period of at least two years. Patients were categorized into two groups based on arthroscopic ATFL grade: Group G, characterized by good to moderate tissue quality with distension or discontinuity of the ATFL; and Group P, characterized by poor tissue quality with a hypoplastic ATFL. Patients with irreparable absent ATFL were excluded. Subjective outcomes were assessed using the visual analogue scale score, Foot and Ankle Outcome Score (FAOS), and the Karlsson ankle functional score. Objective outcomes included posturographic analysis and radiological evaluations, such as stress radiographs and axial view magnetic resonance imaging (MRI). Results: Among 163 patients, 22 were excluded based on predefined criteria, leaving 141 patients for analysis (Group G, n = 77; Group P, n = 64). Patients had a mean age of 32.1 years, and the average follow-up duration was 31.6 months. Both groups exhibited postoperative improvements in subjective and objective clinical outcomes (all p &lt; 0.05). Significantly, Group P demonstrated lower FAOS scores in the sports unit (p = 0.016), an increased fall risk as determined by posturography at the final follow-up (p = 0.019), and a higher retear rate on axial view MRI (10.9%, 7/64) compared to Group G (2.6%, 2/77) (p = 0.044). Conclusion: Arthroscopic all-inside ATFL repair is an effective treatment for CAI, regardless of the quality of the remnant ligament. However, patients with poor ligament quality showed inferior clinical outcomes, especially in sports-related activities and proprioception. Additionally, they experienced a higher retear rate. These findings highlight the significance of performing arthroscopic all-inside ATFL repair selectively for CAI, considering the patient's activity level and the quality of the remaining ligament tissue.

All-inside Technique versus Conventional Full-tunnel Reconstruction for Anterior Cruciate Ligament Tears of the Knee: A Systematic Review and Meta-analysis

Introduction: There is a paucity of evidence in literature regarding the efficacy of all-inside anterior cruciate ligament reconstruction (AIACLR) vis-à-vis the traditionally used full-tunnel (FT) technique. The primary aim of this review, thus, was to shed light on this discrepancy and determine which of the two methods had more optimum results. Methods: PubMed and Cochrane Library databases were systematically searched by two independent reviewers. Selection criteria were laid down as per the patient, intervention, control, and outcome (PICO) format. All included studies were checked for quality and methodological strength using well-defined risk-of-bias assessment tools. Techniques were compared with respect to their graft and tunnel dimensions, functional outcome scores, and complication rates. Data analysis was carried out using the RevMan 5.3® software. Results: A total of 12 articles (six randomized control trials or randomized clinical trials and six prospective/retrospective cohort studies) with 880 knees were included in this study. In most instances of AIACLR, a short and thick quadrupled semitendinosus graft was used for reconstruction. Suspensory fixation devices alone or in combination with interference screws were used for graft fixation. The two techniques were comparable in terms of their functional outcomes, with a slightly lower graft failure rate with AIACLR. Conclusion: The AI technique provides a safe and reliable alternative to conventional ACLR in terms of comparable functional results, reduced postoperative pain, and lower graft failure rates. However, more comparative trials with long-term follow-ups are needed before a definitive statement can be put forward.

Failure and complication rates following meniscal all-inside and inside-out repairs: A systematic review and meta-analysis.

This study examines failure rates, complication rates and patient-reported outcome measures (PROMs) for meniscal all-inside (AI) and inside-out (IO) repair techniques. A systematic search was conducted on PubMed, Embase and Cochrane (inception to January 2024) assessing for Level I-III studies evaluating outcomes after meniscal repair. The primary outcome regarded differences in failure rates between AI and IO repair techniques. Secondary outcomes included a comparison of complication rates and PROMs. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation and Methodological Index for Non-Randomized Studies criteria. A meta-analysis was conducted for outcomes reported by more than three comparative studies. A total of 24 studies (13 studies and 912 menisci for AI vs. 17 studies and 1,117 menisci for IO) were included. The mean follow-up ranges were 22-192 months (AI) and 18.5-155 months (IO). The overall reported AI failure rate ranged from 5% to 35% compared to 0% to 25% within the IO group. When comparing meniscal repair failure rates in the setting of concomitant anterior cruciate ligament reconstruction, the AI group had a failure rate (AI: 5%-34%; IO: 0%-12.9%). The complication rate ranged from 0% to 40% for AI and 0% to 20.5% for IO. Post-operative PROM scores ranged from 81.2 to 93.8 (AI) versus 89.6 to 94 (IO) for IKDC and 4.0-7.02 (AI) versus 4.0-8.0 (IO) for Tegner. Upon pooling of six comparative studies, a significantly lower failure rate favouring the IO technique was observed (15.9% AI vs. 11.1% IO; p = 0.02), although this result was influenced by a study with a predominantly elite athlete population. Moreover, no significant differences were found regarding complication rates between cohorts (7.3% AI vs. 4.8% IO; p = 0.86). The present study underscores comparable clinical success between AI and IO meniscal repair techniques, with both techniques demonstrating similar complication rates. However, the AI repair technique was associated with 1.77 times higher odds of failure compared to the IO cohort. Level III.

Remnant Preservation Anterior Cruciate Ligament Reconstruction: Modified All-Inside Technique With Appendiceal Tibial Tunnel

The number of anterior cruciate ligament (ACL) ruptures treated arthroscopically has increased. In most cases, the rupture of the ligament occurs in the femoral attachment, leaving a robust stump attached to the tibia. ACL reconstruction with stump preservation might have some advantages: rapid reinnervation and revascularization of the graft. Most techniques have used an interference screw in tibial fixation, which could be more difficult to achieve the graft diameter within 8 to 10 mm in most situations. Therefore, we describe a technique for modified “all-inside” ACL reconstruction with remnant preservation using an appendiceal tibial tunnel to optimize the graft size. After tunnel drilling in anatomic positions, the ACL stump is bored centrally up to the diameter of the graft to be passed. After passing the graft from the tibial tunnel to the remnant to the femoral tunnel, adjustable loops are used to fix the femoral side and the tibial side by an appendiceal tibial tunnel.

Retrospective cohort study comparing postoperative joint stability between all-inside PCL reconstruction technique and conventional PCL reconstruction technique in patients with multiligament knee injury

ObjectivesThe purpose of our study was to compare (1) posterior cruciate ligament (PCL) laxity, (2) patient-reported outcome, and (3) complications after the all-inside PCL reconstruction (Al-PCLR) technique and conventional PCLR (CON-PCLR) technique at minimum 2-year follow-up. We hypothesized that AI-PCLR and CONV-PCLR would yield similar results in PCL laxity, patient-reported outcomes, and complications. MethodA retrospective cohort study was conducted on patients who underwent PCLR with the Al-PCLR technique and CON-PCLR technique from 2012 to 2023 in a single hospital. Medical records were reviewed for patients’ demographic data, the technique of PCL reconstruction and complications. Patient-reported outcome scores, including International Knee Documentation Committee (IKDC), Tegner activity scale, and Lysholm score, as well as bilateral kneeling radiographs and physical examinations, were collected at least 2 years postoperatively. ResultsIncluded in the study were 24 patients: 11 who underwent the CON-PCLR technique (mean age 40.7 +years) and 13 who underwent Al-PCLR (mean age 34.3 + 12.9 years). Three patients in AI-PCLR group were lost to follow-up and one patient is the CON-PCLR group, a revision case, was excluded from the study.Bilateral stress kneeling radiographs showed a similar side-to-side difference between two groups (CON-PCLR vs AL-PCLR: mean 7.5 ± 5.2 vs 5.8 ± 4.8 mm; P = 0.38) There were no statically significant differences between the two groups in postoperative IKDC (CON-PCLR vs AL-PCLR: 68.9 vs 73.9; P = 0.37), Lysholm (89.1 vs 94.1; P = 0.42), or Tegner activity (6 vs 6.4; P = 0.68) scores. ConclusionAll-inside PCLR demonstrates comparable stability to Conventional PCLR, with satisfactory patient-report outcome at minimum 2 years follow up and low rate of complications in patients with multiligament knee injury.Level of evidence: III Retrospective comparative study.

Continuous suture all-inside meniscal repair technique produces excellent functional outcomes and return to play rates with a low rate of failure.

The all-inside technique is now the most established treatment for meniscal repair, this usually involves a suture-based repair utilising interrupted sutures. A similar technique using continuous sutures can also be used; however there are no studies in the literature appraising this technique. This study aims to review outcomes for patients undergoing meniscal repair using a continuous suture all-inside technique. We reviewed patients undergoing meniscal repair using a continuous suture all-inside technique over a 5year period. We recorded demographic details, injury type, surgical procedure, incidence of reoperation, functional outcomes (Tegner-Lysholm and International Knee Documentation Committee (IKDC) score) return to sport and failure of repair. Data were collected for 37 patients. Mean age was 25.8years, 81%, were male, median time to theatre was 169days, mean follow-up time was 2.9years. Concurrent ACL ruptures were present in 57%, all underwent ACL reconstruction in the same sitting. The mean Tegner-Lysholm score was 89. Mean IKDC score was 90.2. 78% were able to return to sport. Overall failure rate was 10.81%. Increasing age was associated with a decreased IKDC score (p = 0.02). Tegner-Lysholm score was significantly greater in patients with concurrent ACL injuries (p = 0.03) and patients with lateral meniscal tears (p = 0.04). In the first study to review outcomes following continuous all-inside suture-based meniscal repair we demonstrate excellent clinical outcomes with IKDC, Tegner-Lysholm, return to play and failure rates comparable to other commonly used techniques. We conclude that this is an acceptable and cost-effective technique.

All-Inside Anterior Cruciate Ligament Reconstruction Using Full-Thickness All-Soft-Tissue Quadriceps Tendon Autograft With Independent Suture Tape Augmentation

The anterior cruciate ligament (ACL) is the most frequently injured knee ligament that requires surgical intervention. Surgical options to address ACL ruptures include reconstruction using autograft or allograft or performing primary repair. Subsequent ACL graft failure is a significant postoperative concern in the younger patient population. The addition of suture tape to the final construct is thought to protect the graft during moments of high stress by increasing graft stiffness under high load and preventing substantial graft elongation. Given the normal anatomic lengthening of the ACL from knee flexion to full extension, final fixation of both the suture tape and the graft is done with the knee hyperextended to avoid overconstraint. The use of adjustable loop fixation for both femoral and tibial fixation with the all-inside technique allows the graft to be retensioned after final suture tape fixation and subsequent knee cycling. This ensures that the suture tape is slightly laxer than the graft so that the graft experiences loads that are essential for its healing, with the suture tape sharing the load only during times of high stress.

A Simplified Technique for All-Inside Tibial Socket Retrograde Drill Guiding Using a 2- to 3.5-mm Concentric Cannula Without the All-Inside Tibial Guide Ring

The all-inside anterior cruciate ligament (ACL) technique is a minimally invasive surgical procedure that has gained popularity due to its reduced invasiveness and improved patient outcomes. The establishment of tibial sockets remains a crucial step in ACL reconstruction, which has always been difficult in ACL reconstruction research. For doctors who are not very experienced, this technique of positioning and making sockets requires a special guide ring, and the tunnel entrance is prone to be anterior. Herein, we report a simplified technique using a self-made 2- to 3.5-mm concentric cannula to help surgeons easily master the all-inside technique. Our technique for tibial socket construction does not require the specific tibial guiding ring but uses a traditional tibial guiding ring for full-length tibial tunnel construction. With a 2-mm Kirschner wire and the traditional tibial guiding ring initially locating the tunnel position, the self-made concentric cannula helps combine the Kirschner wire with the guide pin sleeve, thereby impacting the guide pin sleeve into the tibial cortex at a controlled depth. Then, retrograde drilling is performed to create the socket. This technique provides feasible approaches for surgeons to transition from traditional full-long tunnel creation to the semi-long socket construction for the all-inside ACL technique.

Poster 307: Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: 6-Year Follow up Results from the MARS Cohort

Objectives: Meniscal preservation has been demonstrated to contribute to long term knee health and has been a successful intervention in the isolated and ACL reconstructed patient. The long-term results of meniscus repair in the setting of revision ACL reconstruction have yet to be documented. The purpose of this study is to report the incidence of meniscal repair failures at 6-year follow-up in a cohort of patients who underwent concurrent revision ACL reconstruction and meniscal repair. Methods: All revision ACL reconstructions with concomitant meniscal repair cases from a multicenter group between 2006 and 2011 were selected. Six-year follow-up was obtained by both phone and email to determine whether any subsequent surgery had occurred to either knee since their initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify pathologic condition and treatment. Results: In total, 221 patients from 1234 revision ACL reconstructions underwent concurrent meniscal repairs (18% of the cohort). There were 238 repairs performed: 173 medial and 65 lateral. The vast majority of these repairs (n=181; 76%) were performed with an all-inside technique. Baseline patient and surgical characteristics of this group are reported (Tables 1, 2). Six-year surgical follow-up was obtained on 77% (171/221) of the cohort. Overall, the meniscal repair failure rate defined as reoperation was 13% (31/235) at 6 years. Of the 31 failures, 28 were medial (24 all-inside, 4 inside-out; 16% failure rate) and 3 were lateral (2 all-inside, 1 inside-out; 4.6% failure rate; Table 2). Three medial failures were treated in conjunction with a subsequent repeat revision reconstruction. The mean (SD) time to failure for the medial repairs was 2.6 (1.7) years, while the time to failure for the lateral repairs was 1.6 (1.8) years. Medial tears underwent reoperation for failure at a statistically significant higher rate than lateral tears (16% versus 4.6%; p&lt;0.001). Conclusions: Meniscus repair in the revision ACL setting is a successful treatment option when clinically indicated with low failure rates. At 6-year follow-up, overall meniscal failure rate as defined by reoperation was 13% in this revision cohort. Failure rates for medial tears (16%) were higher than for lateral tears (4.6%), which aligns with previous studies both in the revision and primary setting.