Inside-out Tibial Tunnel Drilling Technique for All-inside Anterior Cruciate Ligament Reconstruction

Noronha, José Carlos; Oliveira, JP

doi:10.1016/j.eats.2017.10.008

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…Studies have shown that the failure of ACLR and fixation most often occurs in the tibial socket, which may be because the tibial bone mineral density is lower than that of the femur and the angle between the tibial socket and the intra-articular graft is more collinear than that between the femoral socket and the graft, which makes the axial force of the tibia-graft interface greater [70]. The adjustable loop avoids the complications of interface screws, better fills the bone socket, and reduces graft activity and synovial fluid leakage into the bone socket [29,30]. A recent meta-analysis comparing suspension fixation with aperture fixation found that suspension fixation had more advantages in lateral differences and postoperative graft retear [1].…”

Section: Selection Of Fixation Methodsmentioning

confidence: 99%

“…The all-inside technique is an advantageous ACLR technique that can preserve the gracilis muscle, reduce muscle strength loss of affected limbs, and reduce the risk of knee joint instability under rotational load [29,37]. Studies have shown that preservation of the gracilis muscle is essential for postoperative rehabilitation, especially for patients with a high demand for knee joint movement [38].…”

Section: Characteristics and Advantages Of The All-inside Techniquementioning

confidence: 99%

“…The risk of graft "bottoming-out" during tensioning and fixation [6,17] Fixing mode Graft micro motions caused by suspension system [21] Construction of bone tunnel Destory the stump of ACL when use flipcutter [17,29]…”

Section: Tendonmentioning

confidence: 99%

“…Whichever technique is involved, the construction of the bone socket is based on the understanding of ACL footprints and the evaluation of ruptured ACL scar tissue by biological and anatomical methods under arthroscopy. The all-inside technique, which uses bone sockets to replace the total bone tunnel, retains bone mass and reduces graft movement and synovial fluid leakage [29], while a higher graft failure rate is observed in the total tibial tunnel [74]. Carlos Noronha et al [29] proposed a tibial tunnel drilling technique.…”

Section: Construction Of the Bone Socketmentioning

confidence: 99%

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All-Inside Anterior Cruciate Ligament Reconstruction: A Review of Advance and Trends

Yang¹,

Cai²,

He³

et al. 2022

Front. Biosci. (Landmark Ed)

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Anterior cruciate ligament (ACL) injury is a common disease in orthopedics and mostly occurs as a noncontact injury in athletes. Patients' knee joint stability, which is crucial to their athletic ability, cannot be restored through conservative treatment; it can only be restored through ACLR (ACL reconstruction) surgery. The surgical techniques of ACLR are constantly evolving, from bone tendon bone (BTB) grafting combined with interface screw fixation to hamstring tendon autograft or allogeneic tendon and of suspension device constructs. In particular, the currently prevalent all-inside technique featuring good cosmetic results and quick recovery of early functions not only ensures the stable fixation of grafts but also reduces surgical trauma. This review compares the advantages and disadvantages of different aspects of all-inside ACLR, including graft selection and preparation, bone socket reconstruction, fixation methods, and surgical technique effects and limitations. It has been found that the all-inside technique excels both anatomically and clinically but still requires further development. Besides, it has some limitations, and high-quality randomized controlled trials are still required to compare the long-term effects of the all-inside technique and other ACLR techniques.

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Section: Selection Of Fixation Methodsmentioning

confidence: 99%

Section: Characteristics and Advantages Of The All-inside Techniquementioning

confidence: 99%

Section: Tendonmentioning

confidence: 99%

Section: Construction Of the Bone Socketmentioning

confidence: 99%

See 2 more Smart Citations

All-Inside Anterior Cruciate Ligament Reconstruction: A Review of Advance and Trends

Yang¹,

Cai²,

He³

et al. 2022

Front. Biosci. (Landmark Ed)

View full text Add to dashboard Cite

show abstract

“…Different surgery techniques are commonly applied for ACLR and have been investigated using FE models to predict clinical performance[23,24,30,35,48,51,72,90,95,96].Traditional TT and AM techniques have been extensively studied with FE models to analyze anatomical placement of the femoral and tibial tunnel within the native ACL footprint and to determine forces of the graft during functional motion [23,24,41,96]. Some mixed fi ndings exist when comparing TT and AM techniques.…”

mentioning

confidence: 99%

A review on finite element analysis of the anterior cruciate ligament reconstruction

Simões¹,

Ramos²,

Oliveira³

et al. 2021

Open J Orthop Rheumatol

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A signifi cant number of papers relatively to the investigation made on Anterior Cruciate Ligament (ACL) Reconstruction (ACLR) has been published in orthopaedic related journals. Finite Element (FE) Analysis (FEA) has been used to predict the performance of biomechanical-biomedical systems as well as the effect of clinical factors on the ACLR success. This research tool presents some advantages relatively to experimental studies in assessing stresses and strains in soft tissues of the knee joint. By interpreting correctly FE results, it is possible to extrapolate them to clinical situations. This article reviews papers published from 2016 until nowadays on FEA for ACLR studies searched in Google Scholar, Medline and PubMed databases. Only studies that addressed surgery techniques, type and size of grafts, tunnel geometry and orientation, and fi xation devices are reviewed and presented.

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Inside‐out tibial tunnel drilling technique is a reliable approach for all‐inside ACL reconstruction: A longitudinal MRI assessment

Oliveira,

d'Almeida,

Sampaio

et al. 2024

J. exp. orthop.

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PurposeTo longitudinally evaluate sockets localization, tunnel morphological changes and graft maturation after the inside‐out tibial tunnel drilling technique for all‐inside Anterior Cruciate Ligament Reconstruction (ACLR). We hypothesized that due the necessary angle for the inside‐out reaming procedure, the described technique could input changes in the tibial socket.MethodsFourteen knees treated with the same all‐inside ACLR technique were randomly assigned for a magnetic resonance evaluation. All patients were operated by the same surgeon and performed the same follow‐up rehabilitation protocol. Socket's localization, shape and widening, as well as graft maturation and integration, were evaluated intraoperatively at 6 months and 4 years after surgery.ResultsBoth femoral and tibial tunnels had an expected increase at 6 months follow‐up. The widening was larger in the tibial tunnel (12.6 ± 10.0% vs. 9.1 ± 8.5%), yet this difference was not statistically different. Tibial tunnel was well centred in the tibial plateau and the integration of the graft was higher in the tibial socket. Four years after surgery, there was a general reduction of diameter in both tunnels. The tunnel occlusion rate was 33.3% for tibia and 16.7% for femur.ConclusionsOverall, our results show that within a 4‐year follow‐up period, the inside‐out tibial tunnel drilling technique for all‐inside ACLR represents a safe technique that did not influence the tibial socket position nor tunnel widening or graft maturation in the long term.Level of EvidenceLevel IV.

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Inside-out Tibial Tunnel Drilling Technique for All-inside Anterior Cruciate Ligament Reconstruction

Cited by 6 publications

References 10 publications

All-Inside Anterior Cruciate Ligament Reconstruction: A Review of Advance and Trends

All-Inside Anterior Cruciate Ligament Reconstruction: A Review of Advance and Trends

A review on finite element analysis of the anterior cruciate ligament reconstruction

Inside‐out tibial tunnel drilling technique is a reliable approach for all‐inside ACL reconstruction: A longitudinal MRI assessment

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