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Outcomes of retro-drilled all-inside tibial tunnel vs complete tibial tunnel techniques in anterior cruciate ligament reconstruction—a comparative study

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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

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Availability of data and material

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India

    Tarun Goyal & Lakshmana Das

  2. Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India

    Souvik Paul, Arghya Kundu Choudhury & Siddharth S. Sethy

Authors
  1. Tarun Goyal
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  2. Lakshmana Das
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  3. Souvik Paul
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  4. Arghya Kundu Choudhury
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  5. Siddharth S. Sethy
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Contributions

Dr Tarun Goyal: Planning of study, patient enrolment, writing of manuscript. Dr Lakshmana Das: Data management, manuscript preparation. Dr Souvik Paul: Evaluation of functional outcomes, patient enrolment, writing of manuscript, manuscript preparation. Dr Arghya Kundu Choudhury: Patient enrolment, Data collection. Dr. Siddharth S Sethy: Patient enrolment, Data collection.

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Correspondence to Tarun Goyal.

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The institutional ethics committee approved the study (AIIMS/IEC/18/141).

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Informed consent was obtained from all individual participants included in the study.

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Goyal, T., Das, L., Paul, S. et al. Outcomes of retro-drilled all-inside tibial tunnel vs complete tibial tunnel techniques in anterior cruciate ligament reconstruction—a comparative study. Eur J Orthop Surg Traumatol 32, 523–532 (2022). https://doi.org/10.1007/s00590-021-03011-2

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  • DOI: https://doi.org/10.1007/s00590-021-03011-2

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