Background
Surgical reconstruction of the anterior cruciate ligament (ACL) is one of the most common orthopaedic procedures, with an estimated 175,000 procedures performed annually in USA. Recently, the all-inside reconstruction technique has come into favor and is theorized to be superior to the complete tibial tunnel technique.
Purpose
To compare clinical and patient-reported outcomes (PRO) for hamstring autograft ACL reconstruction (ACLR) performed with an all-inside versus a complete tibial tunnel technique.
Methods
Patients who underwent hamstring autograft ACLR via either an all-inside approach (femoral and tibial sockets) or a complete tibial tunnel approach (femoral socket and full-length, transtibial tunnel) at a single institution between January 2015 and January 2022 were reviewed. Demographic information, preoperative comorbidities, surgical details, physical examination findings, and follow-up outcomes were extracted from the medical record. Physical examination data included pivot-shift, Lachman, and ROM, whereas patient-reported outcomes included the VAS, Tegner -Lysholm knee score, and International Knee Documentation Committee (IKDC) score at a minimum of 2 years after surgery. Return to sport and failures were also analyzed.
Results
A total of 50 patients (mean ± SD age, 28 ± 8.4 years) who underwent all-inside reconstruction (median follow-up, 2.38 years; range, 2-3.2 years) and 50 patients (mean ± SD age, 27.9 ± 8.1 years) who underwent complete tibial tunnel reconstruction (median follow-up, 2.26 years; range, 2-3.2 years) met the inclusion criteria. PRO scores at 3 months, 6 months and latest follow up were comparable between the all-inside versus the complete tibial tunnel groups (VAS score [2w] 1.9 vs 2.1 [4w] 0,4 vs 0.7 Lysholm Tegner score, 96.8 [6m] vs 95.8, P<0.001; IKDC score [1y] 97.7 vs 97.8, P<0,001). Graft failure before the final follow-up was experienced by 8% of patients in the all-inside group compared with 12% in the complete tibial tunnel group. Mean return to everyday activities was 5.8 weeks in the all-inside group versus 9.6 weeks in the complete tibial tunnel group (P <0,05).
Conclusion
All-inside and complete tibial tunnel hamstring autograft ACLR resulted in excellent physical examination findings and PROs at minimum 2-year follow-up. Both techniques successfully restored knee stability and patient function. All inside has statistically significant less pain (P<0.001) and improved scores the first 2 and 4 weeks post- (P<0,05), but the scores has no statistical significance after the first 3 months.