Transportal versus all-inside techniques of anterior cruciate ligament reconstruction: a systematic review

Abstract

Background Transportal (TP) and all-inside techniques (AIT) are the most commonly used anterior cruciate ligament (ACL) reconstruction procedures in current clinical practice. However, there is an ongoing debate over which procedure is superior. Therefore, the purpose of this systematic review was to evaluate and compare the clinical outcomes and complications of these two techniques to propose recommendations for future application. Our primary hypothesis was that AIT is a superior ACLR technique compared to TP. Methods A systematic literature review, using PRISMA guidelines, was conducted using PubMed, Medline, Google Scholar, and EMBASE, up to February 2021 to identify studies focusing on AIT and TP techniques of ACL reconstruction. We excluded animal experiments, cadaveric studies, retrospective studies, case reports, technical notes, and studies without quantitative data. Patients’ characteristics, surgical technical features, along with postoperative follow-up and complications were extracted and reported accordingly. Methodological quality of the included studies was assessed using the Modified Coleman Methodology Score (MCMS). Results A total of 44 studies were selected for this review, of which four were comparative studies. A total of 923 patients underwent AIT and 1678 patients underwent the TP technique for ACLR. A single semitendinosus graft was commonly used in the AIT compard to combined semitendinosus and gracilis graft in the TP group. The postoperative increase in International Knee Documentation Committee (IKDC), Lysholm, KT-1000, and Short Form-12 (physical and mental) scores were similar in the AIT group and the TP group. Contrastingly, the VAS pain score was significantly lower in the AIT group compared to the TP group. Furthermore, the pooled complication rates from all studies were similar between the two groups (AIT: 54 patients, 8.26% vs. PT: 55 patients, 6.62%). However, the four studies that prospectively compared AIT and TP techniques showed lesser complications in the AIT group than the TP group. Conclusion Since the future trend in orthopedic surgery is toward less invasive and patients’ satisfaction with good outcomes, AIT is a good alternative method considering preserving bony tissue and gracilis tendon with less post-operative pain, along with more knee flexor strength and equal outcomes compared to conventional ACL reconstruction surgery. Level of Evidence II.

Effect of Tunnel Drilling Portal on Femoral Tunnel Entry Aperture’s Location in Arthroscopic Anterior Cruciate Ligament Reconstruction

“…A medial arthroscopic portal allows directing the femoral tunnel in a non-vertical location which fulfills the purpose of anteroposterior and rotation stability of the reconstructed ligament. The transportal femoral tunnel drilling through a medial portal is currently the standard method of ACLR [13]. However, several modifications of the medial portal have been described to make femoral tunnel drilling easy and in line with the anatomical ACLR [2,[4][5][6][7][8][9].…”

Promising results of captopril in improving knee arthrofibrosis and cartilage status: an animal model study

“…The most suitable method for diagnosing and treating joint disorders is still a matter of debate [1, 8, 14]. Several studies supported permitting the administration of captopril in normotensive patients without significant complications [20, 23].…”

All-inside vs. conventional method in anterior cruciate ligament (ACL) reconstruction: systematic review and meta-analysis

“…If not treated properly, ACL deficiency knee can cause significant morbidity and long-term impairment. 2 The incidence of ACL injury in the United States of America (USA) was 200,000 cases, half of which required reconstructive surgeries. 3 In Australia, the yearly incidence increased by 43% (from 54.0 to 77.4 per 100,000 people) and by 74% among those under 25 (from 52.6 to 91.4 per 100,000 people).…”