Koh Jun Rui Don, Loh Sir Young James
Changi General Hospital, 2 Simei St 3, Singapore, 529889.
J Orthop. 2024 Apr 4;55:1-10. doi: 10.1016/j.jor.2024.03.041. eCollection 2024 Sep.
The All-Inside PCL Reconstruction is a surgical technique which overcomes some of the key challenges faced with traditional PCL Reconstruction, and is becoming more relevant as the rate of PCL reconstruction increases.The purpose of this study is to review the technical practices of the all-inside PCL reconstruction since it was first introduced, with respect to the various key components involved in the surgical technique, to provide more information to the surgeon of the various surgical options available in practice.
A systematic review was performed by the authors in January 2023 as per Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to identify all studies outlining the all-inside surgical technique in the past decade. The predetermined eligibility criteria were applied in the screening of the literature in Pubmed, Cochrane and Google Scholar databases.
A total of 14 studies were included in the final review, 9 technical studies, 2 case series, 2 book chapters and 1 review. An allograft was the preferred choice in 9 of the 14 studies. The semitendinosus was preferred when an autograft was chosen. Quadruple folding of the graft was the preferred configuration in 11 studies with the graft diameters from 8 to 12 mm and length ranging from 60 to 150 mm. The femur socket length ranged from 15 to 35 mm and the tibia socket length ranged from 20 to 70 mm. All the studies reported the use of at least 3 portals and up to 6 portals was also reported. 13 studies reported the graft docking first into tibia socket followed by the femoral socket. 7 studies reported the graft entry via the AM portal and 6 studies used a lateral portal. 9 studies used augmentation such as suture anchors (6 studies) and suture tape (3 studies). The 30° and 70° arthroscopic lenses were used alternatingly in 8 studies and fluoroscopy was utilized in 10 studies.
The current literature review of all-inside PCL reconstruction consisted mainly technical studies and more clinical outcomes studies are needed to determine its efficacy. It observed a trend to use an allograft, at least 3 portals and docking the graft in the tibia socket first. There is no obvious preference of portal for graft entry.
全内置后交叉韧带重建术是一种外科技术，它克服了传统后交叉韧带重建术面临的一些关键挑战，并且随着后交叉韧带重建率的增加，其相关性也越来越高。本研究的目的是回顾自首次引入全内置后交叉韧带重建术以来的技术实践，涉及手术技术中的各种关键组成部分，为外科医生提供实践中可用的各种手术选择的更多信息。
作者于2023年1月按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行了系统评价，以识别过去十年中概述全内置手术技术的所有研究。在筛选PubMed、Cochrane和谷歌学术数据库中的文献时应用了预先确定的纳入标准。
最终综述共纳入14项研究，9项技术研究、2项病例系列、2章书籍内容和1篇综述。14项研究中有9项首选同种异体移植物。选择自体移植物时，半腱肌是首选。11项研究中移植物的首选构型是四重折叠，移植物直径为8至12毫米，长度为60至150毫米。股骨骨隧道长度为15至35毫米，胫骨骨隧道长度为20至70毫米。所有研究均报告至少使用3个入路，也有报告使用多达6个入路。13项研究报告移植物先对接至胫骨骨隧道，然后对接至股骨骨隧道。7项研究报告移植物经前内侧入路进入，6项研究使用外侧入路。9项研究使用了增强技术，如缝合锚钉（6项研究）和缝合带（3项研究）。8项研究交替使用30°和70°关节镜镜头，10项研究使用了透视。
目前关于全内置后交叉韧带重建术的文献综述主要是技术研究，需要更多的临床结局研究来确定其疗效。观察到使用同种异体移植物、至少3个入路以及先将移植物对接至胫骨骨隧道的趋势存在。对于移植物进入，没有明显的入路偏好。
