No difference at two years between all inside transtibial technique and traditional transtibial technique in anterior cruciate ligament reconstruction

Abstract

Background: one of the most recent technique is the "all inside" anterior cruciate ligament (ACL) reconstruction. One of the main characteristic of this procedure is the sparing of the tibial cortex. Furthermore, the all-inside technique requires only one tendon harvested. Purpose: the present study describes two year clinical outcomes of the all-inside method for ACL reconstruction, and compares them with clinical results of a group of patients treated with the traditional transtibial single-bundle ACL reconstruction technique using the semitendinosus and gracilis tendons (ST-G). Study design: pilot study, using historical controls. Methods: ACL reconstruction was performed on two groups of 20 patients each. The patients in one group underwent the all-inside transtibial technique with ST tendon alone. The second group underwent ACL reconstruction with the traditional transtibial single-bundle procedure using quadrupled ST-G tendons. Follow up at 24 months was undertaken using the IKDC, VAS pain score, Lysholm and Tegner scales. Results: the VAS pain score for the traditional ACL group was 84.6 ± 12.6; whereas the score for the all-inside group was 81.6 ± 13.1, with no statistically significant differences between the two groups. In the traditional ACL reconstruction group the Lysholm scale gave a "good results" for 7 patient (35%) and "excellent results" for 13 patients (65%) and the all-inside group gave "sufficient results" for 4 patients (20%), "good results" for 7 patients (35%) and "excellent results" for 9 patients (45%) (n.s.). The median of Tegner score was 6.5 (2-10) for the standard method group and 6 (1-9) for the all-inside group (n.s). The IKDC evaluated 50% of patients from the standard technique group as class A, and 45% as class B and 5% as class C. As regards patients of the all inside technique 55% were class A, 40% class B and, here too, just 5% scored as class C. No patients were classed as group D in each group. Conclusions: this study suggests that, in respect to return to sports and adequate articular function, there are no differences between the all-inside transtibial ACL reconstruction technique and the traditional transtibial ACL reconstruction using ST-G. The role of all-inside transtibial ACL reconstruction remains dubious. Level of evidence: III or Level C according with Oxford Center of EBM.

Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis

“…However, the data could not be pooled, given it was assessed in different ways and at different times. The individual studies reported comparable postoperative pain and analgesic consumption for both the all-inside and full tibial tunnel groups at all follow-up times [12,13,15]. Return to sports was investigated by two studies [8,11]; however, the data were recorded in a different time frame.…”

“…The selected studies reported that the study period included the surgeon's learning curve on the newly developed all-inside technique. The unfamiliarity with the surgical instrument and fixation device might be the cause of all these complications [3,8,9,12,13]. Fig.…”

Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis

“…However, the data could not be pooled, given it was assessed in different ways and at different times. The individual studies reported comparable postoperative pain and analgesic consumption for both the allinside and full tibial tunnel groups at all follow-up times (12,14,19). Return to sports was investigated by two studies (15,16); however, the data were recorded in a different time frame.…”

“…In autologous graft selection, six studies (3,14,(16)(17)(18)(19) used quadrupled semitendinosus tendon (ST4) in the all-inside group and double gracilis and semitendinosus tendon (DGST) in the full tibial tunnel group; one study did not clearly mention the autologous tendon graft donor site (15). All the studies mentioned the suspensory cortical button graft fixation device was used on both the femoral and tibial side in the all-inside group of patients.…”

Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis

“…However, the data could not be pooled, given it was assessed in different ways and at different times. The individual studies reported comparable postoperative pain and analgesic consumption for both the all-inside and full tibial tunnel groups at all follow-up times (12,14,19). Return to sports was investigated by two studies (15,16); however, the data were recorded in a different time frame.…”