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. 2024 Feb 12;34(1):11970.
doi: 10.4081/ejtm.2024.11970.

The healing effect of the all inside technique is superior to the traditional technique in the reconstruction of the anterior cruciate ligament

Xiong Li  1 , Wu Cao  2 , Hongyu Zhou  3 , Ruida Ji  4 , Jian Xiao  5 , Chen Zhao  6
Affiliations

The healing effect of the all inside technique is superior to the traditional technique in the reconstruction of the anterior cruciate ligament

Xiong Li et al. Eur J Transl Myol. .

Abstract

Our main objective was to examine the curative effect of all inside technique and traditional technique in anterior cruciate ligament (ACL) reconstruction. In our retrospective study at the First People's Hospital of Jiashan County, we analyzed 88 participants with ACL injuries (50 males, 38 females, average age 27 years). They were randomly divided into two groups: traditional ACL reconstruction (42 participants) and all inside ACL reconstruction (46 participants). We measured and recorded the Visual Analog Scores (VAS), International Knee Documentation Committee (IKDC), Lysholm scores, operation time, graft diameter and length between the traditional technique group and all inside technique group. There were statistically significant differences in the Lysholm scores and IKDC scores between traditional and all inside technique groups. The all inside technique showed a higher efficacy and effective post-operative recovery with minimal pain and recurrent injuries. Our findings showed that the differences in gender, age, side of injury and operation time were not significant (p> 0.05). Follow-up was conducted at 6 months and 12 months post operations (mean, 7.5 ± 1.1 months). All inside technique minimizing tissue disruption, optimizing graft placement and facilitating early recovery have a significant impact on patient outcomes.

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Conflict of interest statement

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The anterior cruciate ligament (ACL) is a critical component of the knee joint, playing a pivotal role in maintaining stability and controlling motion. Rodriguez et al., suggested that the significance of the ACL becomes apparent when it sustains an injury, as a tear or rupture can lead to debilitating symptoms, including pain, instability, and limitations in daily activities and sports participation. According to An et al., in response to ACL injuries, surgical intervention has emerged as a cornerstone approach to restoring knee joint function and preventing long-term joint damage. Consequently, ACL reconstruction has become a widely accepted approach to restoring knee joint stability and function in individuals suffering from ACL injuries.

According to Marieswaran et al., the ACL is one of the four primary ligaments within the knee joint, situated centrally to provide critical stability. Its primary function is to prevent excessive anterior translation of the tibia relative to the femur and control rotational forces during knee motion. Due to its crucial role in knee joint stability, injuries to the ACL are relatively common, especially in activities involving pivoting, cutting, and sudden direction changes. A diverse array of surgical techniques has evolved over time for ACL reconstruction, each with unique characteristics and goals. The primary objective of these procedures is to replace the injured or torn ACL with a graft, often harvested from the patient's own tissues or procured from a donor source.

Mengaji et al., suggested that traditional ACL reconstruction techniques represent a time-tested and widely adopted approach to addressing ACL injuries. This method involves the creation of tunnels within both the tibia and femur to facilitate the secure placement of the graft. These tunnels serve as anchor points for the graft material, enabling it to mimic the function of the damaged ACL., One of the critical decisions in traditional ACL reconstruction is the choice of graft material. Orthopaedic surgeons typically consider autografts and allografts.,

According to Baawa-Ameyaw et al., autografts involve using the patient's own tissue to reconstruct the ACL. The most commonly utilized autografts are sourced from the patient's patellar tendon or hamstring tendon. The choice between these two depends on various factors, including the surgeon's preference, patient characteristics, and individual knee anatomy. Solie et al., suggested that patellar tendon autografts are renowned for their robustness and ability to restore stability effectively. Hamstring tendon autografts, on the other hand, are valued for their less invasive harvesting technique and potential for reduced postoperative morbidity.

According to Lee et al., allografts employ tissue harvested from cadaveric donors. This approach eliminates the need for harvesting tissue from the patient's body, potentially reducing donor site morbidity. Allografts can be derived from various sources, including Achilles tendon, patellar tendon, or hamstring tendon., While allografts offer advantages related to surgical simplicity and decreased donor site complications, there is a debate about their long-term outcomes compared to autografts.

According to Martinez-Cano et al., the traditional ACL reconstruction procedure typically involves an arthroscopic approach. Small incisions are made around the knee joint, allowing for the insertion of an arthroscope (a small camera) and specialized instruments. The torn ACL remnants are removed, and the tunnels are created in both the tibia and femur using precision drills. The graft is then prepared and positioned in these tunnels. Fixation devices such as screws, interference screws, or suspensory devices are used to secure the graft firmly in place.

The All Inside Technique, as proposed by An et al., represents a modern shift in ACL reconstruction, aiming to minimize tissue disruption while restoring ACL function. Unlike traditional methods with tibial and femoral tunnels, it relies on an internal approach, anchoring the graft within the knee joint itself. This technique starts with arthroscopy and small incisions, preserving healthy tissue and using internal anchoring mechanisms like bioabsorbable implants, sutures, or fixation devices instead of external tunnels.

Aboalata et al., introduced the Anterior Internal Substitution Technique (AIST) as an innovative ACL reconstruction approach, known for favourable patient outcomes and faster recovery. AIST involves arthroscopy, with small incisions for instrument insertion, akin to traditional and all inside techniques. AIST is distinct for its internal graft placement within the knee joint, differing from traditional methods with external tunnels. It secures the graft internally using techniques like sutures, implants, or specialized devices.

Our main objective is to assess the curative effect of all inside technique and traditional technique in anterior cruciate ligament reconstruction.

[Table: see text]

[Table: see text]

Figures

Fig 1.
Fig 1.
Flowchart of participant’s selection and eligibility.
Fig 2.
Fig 2.
Flowchart of the rehabilitation and post-operative care.
Fig 3.
Fig 3.
Follow-up duration between groups.
Fig 4.
Fig 4.
A comparison of IKDC scores pre-operatively, 6 months and 12 months post-operation between the experimental groups.
Fig 5.
Fig 5.
A comparison of Lysholm scores pre-operatively, 6 months and 12 months post-operation between experimental groups.
See this image and copyright information in PMC

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