Comparative analysis of tunnel enlargement after reconstruction of the anterior cruciate ligament of the knee by all-inside versus conventional tunneling methods
10.3760/cma.j.cn121113-20240122-00046
- VernacularTitle:全内与传统隧道技术重建前十字韧带术后隧道扩大程度及疗效的比较
- Author:
Chengyuan YAN
1
;
Chao FANG
;
Jingyu GAO
;
Qichun ZHAO
Author Information
1. 皖南医学院，芜湖 241002
- Keywords:
Anterior cruciate ligament injuries;
Anterior cruciate ligament reconstruction;
Arthroscopy;
All-inside technique
- From:
Chinese Journal of Orthopaedics
2024;44(7):447-455
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the postoperative tunnel enlargement and clinical outcomes of anterior cruciate ligament (ACL) reconstruction using the all-inside technique with the traditional outside-in graft introduction technique.Methods:A retrospective analysis was conducted on 47 patients with ACL injuries who were admitted to the First Hospital of the University of Science and Technology of China between December 2021 and July 2022. The patients were categorized into two groups based on the surgical approach used for ACL reconstruction. There were 25 cases in the all-inside group, 18 males and 7 females, aged 27.72±7.33 years, 17 cases on the left side and 8 cases on the right side; 22 cases in the traditional group, 11 males and 11 females, aged 27.82±7.12 years, 11 cases on the left side and 11 cases on the right side. Clinical parameters including the length of hospital stay, surgical duration, pain levels assessed via the visual analogue scale (VAS), Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner score were recorded and compared between the two groups. Additionally, femoral and tibial tunnel enlargement was evaluated using postoperative CT scans conducted one year after surgery.Results:All patients were followed up for 15.64±2.04 months (range, 12-21 months). The mean operation time was 178.60±42.90 min in the all-inside group and 133.60±28.77 min in the traditional group, indicating a statistically significant longer operation time in the all-inside group ( P<0.05). On postoperative days 1 and 15, the VAS scores were lower in the all-inside group (7.08±1.29 and 5.56±1.33 points) compared to the conventional group (7.96±1.29 and 6.32±1.13 points), with a statistically significant difference ( P<0.05). However, the differences in VAS scores between the two groups at postoperative months 1, 6, and 12 were not statistically significant ( P>0.05). The preoperative Lysholm, IKDC, and Tegner scores in the all-inside group and the conventional group were 34.00±18.63, 36.24±15.01, 1.20±1.12 points and 36.18±13.64, 38.23±14.94, 1.55±1.14 points, respectively, and at 6 months after surgery, respectively were 72.60±13.95, 74.12±12.03, 3.56±1.05 points, and 68.41±10.80, 66.59±17.93, 3.23±1.15 points, and at 12 months postoperatively were 92.32±5.23, 81.40±7.24, 5.28±1.62 points and 91.27±6.32, 82.18±7.26, 4.96±1.25 points. Both groups improved at 6 months postoperatively compared with preoperatively ( P<0.05), and further improved at 12 months postoperatively compared with 6 months postoperatively ( P<0.05), but the differences in each functional score between the two groups were not statistically significant at all time points ( P>0.05). At 1 year postoperatively, the values of femoral and tibial tunnel enlargement in the all-inside group (1.78±1.03 mm, 1.18±0.97 mm) were smaller than those in the conventional group (2.30±1.33 mm, 1.83±1.00 mm), and the differences were statistically significant ( P<0.05). The difference between the femoral side tunnel enlargement and tibial side enlargement in the traditional group was not statistically significant ( P>0.05), while the femoral side enlargement in the all-inside group was significantly larger than the tibial side ( P<0.05). The difference in Lysholm, IKDC and Tegner scores between grade 0 and grade 1 tunnel enlargement on the femoral side and tibial side was not statistically significant ( P>0.05). Conclusion:The short-term clinical outcomes following ACL reconstruction using the all-inside technique versus the traditional tunnel technique were comparable. However, early postoperative pain was less severe with the all-inside technique, and tunnel enlargement was smaller. The degree of bone tunnel enlargement did not significantly impact early clinical outcomes.
