Clinical and Functional Outcome of Anterior Cruciate Ligament Reconstruction with Hamstring Autograft: a Comparison study of All-Inside versus Complete Tibial Tunnel Techniques
Dimitrios Nikolopoulos*, George Safos, Spyros Bonazzos, Neoptolemos Sergides, Konstantinos Moustakas, Petros Safos, Gregorios Kyriakopoulos, Baltzis Stamatis and Andreas Moutsios-Rentzos
ABSTRACT
Purpose: The purpose of our study is to compare the clinical and functional outcomes for anatomic ACL reconstruction (ACLR) using the all-inside technique versus a complete tibial tunnel technique (min. follow-up 24 months).
Materials and Methods: Patients who underwent hamstring autograft ACLR via either an all-inside approach or a complete tibial tunnel approach (femoral socket and full-length, transtibial tunnel) at a single institution between 2015 and 2022 were reviewed. Demographic information, preoperative comorbidities, surgical details, physical examination findings (pivot-shift, Lachman, and ROM) and follow-up outcomes (VAS, Tegner -Lysholm score, and IKDC were extracted from the medical record. 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 (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. Patient-reported outcomes (PROs) scores at 3, 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 - VAS score [4w] 0,4 vs 0.7 - Lysholm Tegner score [6m] 96.8 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 versus 9.6 weeks in the complete tibial tunnel group (P <0,05).
Conclusion: Both techniques resulted in excellent physical examination findings and PROs at minimum 2-year follow-up; and successfully restored knee stability and patient function. All inside has statistically significant less pain and improved scores the first 2 and 4 weeks postoperatively.
Level of evidence: Cohort study; III.
