Goyal Tarun, Das Lakshmana, Paul Souvik, Choudhury Arghya Kundu, Sethy Siddharth S
Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
Eur J Orthop Surg Traumatol. 2022 Apr;32(3):523-532. doi: 10.1007/s00590-021-03011-2. Epub 2021 May 24.
The all-inside tibial tunnel preparation technique of arthroscopic anterior cruciate ligament (ACL) reconstruction differs from traditional complete tibial tunnel technique in using closed tibial sockets, dual-cortical suspensory graft-fixation, quadrupled semitendinosus tendon graft and lesser bone removal. The study aims to find out if all-inside technique differs from complete tibial tunnel technique of single bundle ACL reconstruction in terms of graft dimensions, functional and clinical outcomes.
A prospective comparative study was conducted including 80 patients with isolated ACL tears, divided into 2 groups of 40 patients each without any randomization. The two techniques differed in tibial tunnel preparation. Group 1 underwent ACL reconstruction with a complete tibial tunnel drilled from the anteromedial tibial cortex and group 2 underwent all-inside tibial socket preparation. Duration of the surgery, perioperative and midterm complications were noted. All patients had 24 month follow-up. Functional outcome scores (Tegner-Lysholm knee scoring scale and IKDC score) were assessed preoperatively and postoperatively at 6 months and 24 months. Hamstring and quadriceps muscle strength was assessed preoperatively and postoperatively at 6 months, 9 months and 24 months. Visual analogue score (VAS) for knee pain was assessed preoperatively and postoperatively at day 2, 2 weeks, 6 weeks, 6 months and 24 months.
Quadrupled semitendinosus tendon graft was significantly thicker than doubled semitendinosus and gracilis tendons graft (8.17 ± 0.58 vs 8.71 ± 0.4, p < 0.0001). The VAS score for knee pain at 2 and 6 weeks were lower in group 2 (5.75 ± 0.6 and 1.78 ± 1.0) as compared to group 1 (6.50 ± 0.5 and 2.5 ± 0.8) and the difference was statistically significant (P = 0.0007 and p = 0.002 respectively). There were no statistically significant differences in functional outcome scores and quadriceps muscle strength between the two groups. However, there were significant difference in hamstring power in two groups.
The all-inside technique has the advantages of using a single tendon graft, lesser early postoperative pain with similar clinical and functional outcomes compared to the complete tibial tunnel technique. Level of Evidence IIProspective comparative study.
关节镜下前交叉韧带（ACL）重建的全内置胫骨隧道制备技术与传统的完整胫骨隧道技术不同，它采用封闭的胫骨套接、双皮质悬吊移植物固定、四倍半腱肌腱移植物和较少的骨切除。本研究旨在探讨全内置技术与单束ACL重建的完整胫骨隧道技术在移植物尺寸、功能和临床结果方面是否存在差异。
进行了一项前瞻性比较研究，纳入80例孤立性ACL撕裂患者，分为两组，每组40例，未进行随机分组。两种技术在胫骨隧道制备上有所不同。第1组采用从前内侧胫骨皮质钻出完整胫骨隧道的方法进行ACL重建，第2组采用全内置胫骨套接制备方法。记录手术持续时间、围手术期和中期并发症。所有患者均随访24个月。术前、术后6个月和24个月评估功能结果评分（Tegner-Lysholm膝关节评分量表和IKDC评分）。术前、术后6个月、9个月和24个月评估腘绳肌和股四头肌力量。术前、术后第2天、2周、6周、6个月和24个月评估膝关节疼痛的视觉模拟评分（VAS）。
四倍半腱肌腱移植物明显比双股半腱肌和股薄肌腱移植物厚（8.17±0.58对8.71±0.4，p<0.0001）。与第1组（6.50±0.5和2.5±0.8）相比，第2组在术后2周和6周时膝关节疼痛的VAS评分较低（5.75±0.6和1.78±1.0），差异具有统计学意义（分别为P=0.0007和p=0.002）。两组在功能结果评分和股四头肌力量方面无统计学显著差异。然而，两组在腘绳肌力量方面存在显著差异。
与完整胫骨隧道技术相比，全内置技术具有使用单束肌腱移植物、术后早期疼痛较轻且临床和功能结果相似的优点。证据等级II前瞻性比较研究。
