Randomized controlled trial of all-inside and standard single-bundle anterior cruciate ligament reconstruction with functional, MRI-based graft maturity and patient-reported outcome measures

Abstract

Background: All-inside anterior cruciate ligament reconstruction (ACLR) is a novel technique that has gained attention due to its minimally invasive and graft-saving properties. However, studies comparing MRI-based graft maturity between all-inside and standard ACLR are lacking.

Purpose: This study focused on the functional, knee laxity, and MRI-based graft maturity characteristics of all-inside and standard single-bundle ACLR.

Study design: Randomized controlled trial (RCT).

Methods: Fifty-four patients were randomly assigned to an all-inside reconstruction group (n = 27) or standard reconstruction group (n = 27). Using the same rehabilitation strategy. The Tegner, International Knee Documentation Committee, and Lysholm scores were recorded at postoperative months 3, 6, and 12 to assess functional recovery. MRI was conducted to measure the signal/noise quotient (SNQ) of the intra-articular graft to assess the maturity. A higher SNQ indicates lower graft maturity. Knee laxity was assessed using GNRB arthrometer at the postoperative month 12.

Results: The graft SNQ of the all-inside group was significantly higher than that of the standard group at postoperative month 6 (p < 0.05). There was no statistical difference in graft SNQ between the two groups at postoperative months 3 and 12 (p > 0.05). Both groups exhibited the highest SNQ in the middle region of the graft, followed by the proximal region, and the distal region. Functional scores improved significantly for both groups and had no statistical difference (p > 0.05). The knee laxity was higher in the all-inside group (p < 0.05) at postoperative month 12. There was no correlation between the functional scores and graft maturity in both groups (p > 0.05).

Conclusions: All-inside and standard single-bundle ACLR show good functional outcomes; however, knee laxity was relatively higher in the all-inside ACLR group than in the standard ACLR group. Moreover, both techniques exhibited poor maturity in the middle graft region and the best in the distal region. Graft maturity with all-inside ACLR is inferior to that with standard ACLR in the early postoperative stages. There is no correlation between knee function and graft maturity.

Trial registration: Clinical trial registration numbers: ChiCTR1800018543 . Date of registration: 09/23/2018.

Keywords: All-inside; Anterior cruciate ligament reconstruction; Graft maturity; Knee laxity; Single-bundle.

Fig. 1

Flow diagram of the whole study

Fig. 2

Location of the proximal, distal, and middle regions of interest (ROI) of the intra-articular graft, and the location of the quadriceps tendon and background ROI

Fig. 3

Tendon graft preparation and drilling of the tunnel bone socket structure in the all-inside single-bundle anterior cruciate ligament reconstruction technique

Fig. 4

Signal/noise quotient (SNQ) of the proximal, distal, and middle ROIs of the all-inside and standard groups at postoperative months 3, 6, and 12. Both groups showed the highest SNQ in the middle region of the graft, followed by the proximal region, and the distal region. The SNQ of the all-inside group was the highest in June and then decreased, whereas the SNQ of the standard group gradually increased. #, ##, _*, and △ indicate a statistical difference. M ± SD, mean ± standard deviation

Fig. 5

Signal/noise quotient (SNQ) of the proximal, distal, and middle ROIs of the all-inside and standard groups at postoperative months 3, 6, and 12. The SNQ of the all-inside group in the middle and distal regions was significantly higher than that of the standard group at postoperative month 6 (p < 0.05). There was no statistical difference between the rest of the time or region (p > 0.05)