FUNCTIONAL OUTCOME OF ARTHROSCOPIC ACL INSIDE ACL RECONSTRUCTION VERSUS COMPLETE TIBIAL TUNNEL

Main Article Content

Muhammad Imran Haider
Adnan Nazir
Muhammad Imran Anjum
Ahmad Jamal
Muhammad Adeel Razzaque
Zahid Iqbal

Keywords

Arthroscopic ACL Reconstruction, All Inside Technique, Complete Tibial Tunnel Technique, Patient-Reported Outcomes (PROs)

Abstract

Background: Anterior cruciate ligament (ACL) injuries are a common occurrence in the field of orthopedics and sports medicine, often requiring surgical intervention to restore knee stability as well as activity.


Objective: This study's objective was to compare the results of a large patient cohort undergoing ACL restoration utilizing the Complete Tibial Tunnel (CTT) approach with the All Inside Technique (AIT).


Methodology: A research conducted at many medical facilities from January 2021 to July 2023 included 80 patients, ages 18 to 45, who had MRI-confirmed ACL injuries. Two groups of patients had All Inside Group (AIG) and Complete Tibial Tunnel Group (CTTG) ACL restoration, with different surgical procedures used according to the surgeon's discretion. Standard procedures were followed throughout postoperative rehabilitation, and statistical analysis was used to evaluate results using t-tests, chi-square tests, descriptive statistics, hypothesis testing, and Kaplan-Meier survival analysis. Significance was defined as p<0.05.


Results: The research assessed the baseline characteristics, injuries, surgeries, and complications of the two groups, which consisted of 38 persons in the AI group (mean ± SD age: 24.7 ± 10.3 years) and 42 individuals in the CTTG group (mean ± SD age: 20.2 ± 6.9 years).Comparable results were seen for the Patient-Reported Outcomes (PRO) in the most frequent follow-up: Tegner activity score (6.3 vs. 5.7, with a p-value of 0.042), IKDC score (92.7 vs. 89.2, with a p-value of 0.387), and Lysholm score (92.6 vs. 90.8, with a p-value of 0.593). In general 13 of 42 participants (30.95%) in the CTTG and 4 of 38 participants (10.52%) in the AIG failed before the end of follow-up (P= 0.300). While the CTTG and AIG had a mean return to sport of 9.9 months and 11.5 months (P=0.038), respectively.


Conclusion: In conclusion, the study compared ACL reconstruction techniques, favoring the All Inside Technique (AIG) due to its slightly higher Tegner score, lower failure rate, and a slightly longer return to sport time, highlighting its potential as a promising surgical approach for improved patient outcomes.

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References

1. LaBella CR, Hennrikus W, Hewett TE, Council on Sports Medicine and Fitness, and Section on Orthopaedics, Brenner JS, Brookes MA, Demorest RA, Halstead ME, Kelly AK, Koutures CG, LaBella CR. Anterior cruciate ligament injuries: diagnosis, treatment, and prevention. Pediatrics. 2014 May 1;133(5):e1437-50.
2. Siegel L, Vandenakker-Albanese C, Siegel D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clinical Journal of Sport Medicine. 2012 Jul 1;22(4):349-55.
3. Shanmugaraj A, Weidman M, Peterson DC, Simunovic N, Musahl V, Ayeni OR. All-inside anterior cruciate ligament reconstruction—a systematic review of techniques, outcomes, and complications. The Journal of Knee Surgery. 2018 Oct;31(09):895-904.
4. Lee KB, Wang VT, Chan YH, Hui JH. A novel, minimally-invasive technique of cartilage repair in the human knee using arthroscopic microfracture and injections of mesenchymal stem cells and hyaluronic acid—a prospective comparative study on safety and short-term efficacy. Ann Acad Med Singapore. 2012 Nov 1;41(11):511-7.
5. Sprowls GR, Robin BN. The quad link technique for an all-soft-tissue quadriceps graft in minimally invasive, all-inside anterior cruciate ligament reconstruction. Arthroscopy Techniques. 2018 Aug 1;7(8):e845-52.
6. Carr AJ, Price AJ, Glyn-Jones S, Rees JL. Advances in arthroscopy—indications and therapeutic applications. Nature Reviews Rheumatology. 2015 Feb;11(2):77-85.
7. Fu CW, Chen WC, Lu YC. Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2020 Dec;21:1-3.
8. Goyal T, Das L, Paul S, Choudhury AK, Sethy SS. Outcomes of retro-drilled all-inside tibial tunnel vs complete tibial tunnel techniques in anterior cruciate ligament reconstruction—a comparative study. European Journal of Orthopaedic Surgery & Traumatology. 2022 Apr;32(3):523-32.
9. Eichinger M, Ploner M, Degenhart G, Rudisch A, Smekal V, Attal R, Mayr R. Tunnel widening after ACL reconstruction with different fixation techniques: aperture fixation with biodegradable interference screws versus all-inside technique with suspensory cortical buttons. 5-year data from a prospective randomized trial. Archives of Orthopaedic and Trauma Surgery. 2023 Aug 5:1-2.
10. Monaco E, Fabbri M, Redler A, Gaj E, De Carli A, Argento G, Saithna A, Ferretti A. Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation. Knee Surgery, Sports Traumatology, Arthroscopy. 2019 Aug 1;27:2577-84.
11. Roy S, Fernhout M, Stanley R, McGee M, Carbone T, Field JR, Dobson P. Tibial interference screw fixation in anterior cruciate ligament reconstruction with and without autograft bone augmentation. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2010 Jul 1;26(7):949-56.
12. Cartwright-Terry M, Yates J, Tan CK, Pengas IP, Banks JV, McNicholas MJ. Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014 Jul 1;30(7):811-7.
13. Briggs KK, Steadman JR, Hay CJ, Hines SL. Lysholm score and Tegner activity level in individuals with normal knees. The American journal of sports medicine. 2009 May;37(5):898-901.
14. Tegner YE, Lysholm JA. Rating systems in the evaluation of knee ligament injuries. Clinical Orthopaedics and Related Research (1976-2007). 1985 Sep 1;198:42-9.
15. Benea H, d’Astorg H, Klouche S, Bauer T, Tomoaia G, Hardy P. Pain evaluation after all-inside anterior cruciate ligament reconstruction and short term functional results of a prospective randomized study. The Knee. 2014 Jan 1;21(1):102-6.
16. Lubowitz JH, Schwartzberg R, Smith P. Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel. Arthroscopy. 2013;29(7):1195-1200.
17. Mitsou A, Vallianatos P, Piskopakis N, Maheras S. Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty. J Bone Joint Surg Br. 1990;72(3):398-404.
18. Schurz M, Tiefenboeck TM, Winnisch M, Syre S, Plachel F, Steiner G, Hajdu S, Hofbauer M. Clinical and functional outcome of all-inside anterior cruciate ligament reconstruction at a minimum of 2 years’ follow-up. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2016 Feb 1;32(2):332-7.
19. Yasen SK, Borton ZM, Eyre-Brook AI, Palmer HC, Cotterill ST, Risebury MJ, Wilson AJ. Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction. The Knee. 2017 Jan 1;24(1):55-62.
20. Connaughton AJ, Geeslin AG, Uggen CW. All-inside ACL reconstruction: How does it compare to standard ACL reconstruction techniques?. Journal of orthopaedics. 2017 Jun 1;14(2):241-6.