Randomized controlled trial of all-inside and standard single-bundle anterior cruciate ligament reconstruction with functional, MRI-based graft maturity and patient-reported outcome measures

Abstract

Background All-inside anterior cruciate ligament reconstruction (ACLR) is a novel technique that has gained attention due to its minimally invasive and graft-saving properties. However, studies comparing MRI-based graft maturity between all-inside and standard ACLR are lacking. Purpose This study focused on the functional, knee laxity, and MRI-based graft maturity characteristics of all-inside and standard single-bundle ACLR. Study Design Randomized controlled trial (RCT). Methods Fifty-four patients were randomly assigned to an all-inside reconstruction group (n = 27) or standard reconstruction group (n = 27). Using the same rehabilitation strategy. The Tegner, International Knee Documentation Committee, and Lysholm scores were recorded at postoperative months 3, 6, and 12 to assess functional recovery. MRI was conducted to measure the signal/noise quotient (SNQ) of the intra-articular graft to assess the maturity. A higher SNQ indicates lower graft maturity. Knee laxity was assessed using GNRB arthrometer at the postoperative month 12. Results The graft SNQ of the all-inside group was significantly higher than that of the standard group at postoperative month 6 (p < 0.05). There was no statistical difference in graft SNQ between the two groups at postoperative months 3 and 12 (p > 0.05). Both groups exhibited the highest SNQ in the middle region of the graft, followed by the proximal region, and the distal region. Functional scores improved significantly for both groups and had no statistical difference (p > 0.05). The knee laxity was higher in the all-inside group (p < 0.05) at postoperative month 12. There was no correlation between the functional scores and graft maturity in both groups (p > 0.05). Conclusions All-inside and standard single-bundle ACLR show good functional outcomes; however, knee laxity was relatively higher in the all-inside ACLR group than in the standard ACLR group. Moreover, both techniques exhibited poor maturity in the middle graft region and the best in the distal region. Graft maturity with all-inside ACLR is inferior to that with standard ACLR in the early postoperative stages. There is no correlation between knee function and graft maturity. Trial registration Clinical trial registration numbers: ChiCTR1800018543. Date of registration: 09/23/2018.

All-inside versus complete tibial tunnel techniques in anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomized controlled trials

“…The final IKDC subjective scores were obtained from the last follow-up of each study. Six studies [ 11 , 20 , 22 – 25 ] reported IKDC subjective score, and no heterogeneity was found ( p = 0.50; I2 = 0%). The fixation effect model was used, and the results showed that there was no significant difference between the 2 groups (MD = 2.22; 95% CI, 0.23–4.22; p = 0.03), indicating no difference in Final IKDC Subjective scale between the study and control groups (Fig.…”

“…It was used in conjunction with the Lysholm Knee Scoring scale to assess knee function. Four studies [ 21 , 22 , 24 , 25 ] reported Tegner scale, and no heterogeneity was found ( p = 0.61; I2 = 0%). The fixation effect model was used, and the results showed that there was a significant difference between the 2 groups (MD = 0.41; 95% CI, 0.11–0.71; p < 0.01), indicating that the All-inside group was superior to the complete tibial tunnel group in Tegner score (Fig.…”

“…Four studies [ 11 , 20 , 22 , 24 ] investigated the anteroposterior knee stability of the operative knee using the KT-1000 arthrometer (MedMetric Corporation, San Diego, CA, USA) [ 11 , 20 , 24 ], and one study [ 22 ] used the GNRB arthrometer (Genourob, France). We excluded one study [ 20 ] that did not knee anterior laxity measured.…”

A novel home-based rehabilitative knee brace system is a viable option for postoperative rehabilitation after anterior cruciate ligament reconstruction: a report of 15 cases

“…Regarding the degree of postoperative stability, the present study found a mean value of 1.8 mm in SSD of anterior tibial translation under 134 N at postoperative 6 months. In the previous studies [ 12 , 16 , 22 , 23 ], values measured by GNRB arthrometer after ACL reconstruction ranged from 1.5 mm to 3.4 mm. Although different studies cannot be compared directly, the results in the present study suggested that the dynamic anterior stability seemed to be adequate when compared with previous studies [ 12 , 16 , 22 , 23 ].…”

“…In the previous studies [ 12 , 16 , 22 , 23 ], values measured by GNRB arthrometer after ACL reconstruction ranged from 1.5 mm to 3.4 mm. Although different studies cannot be compared directly, the results in the present study suggested that the dynamic anterior stability seemed to be adequate when compared with previous studies [ 12 , 16 , 22 , 23 ].…”