Comparative study of the clinical efficacy of all-inside and traditional techniques in anterior cruciate ligament reconstruction

BACKGROUND Many studies have focused on the femoral tunnel technique and fixation method,but few studies have involved the tibial tunnel technique and fixation method.The all-inside technique is one of the new techniques that has been described in recent years.All-inside anterior cruciate ligament(ACL)reconstruction is based on a tibial socket instead of a full tunnel.This method has many potential advantages.AIM To compare clinical outcomes of knee ACL autograft reconstruction using allinside quadrupled semitendinosus(AIST)and traditional hamstring tendon(TBT)techniques.METHODS From January 2017 to October 2019,the clinical data of 80 patients with ACL reconstruction were retrospectively analyzed,including 67 males and 13 females.The patients had an average age of 24.3±3.1 years(age range:18-33 years).The AIST technique was used in 42 patients and the TBT technique was used in 38 patients.The time between operation and injury,operative duration,postoperative visual analogue scale(VAS)score and knee functional recovery were recorded and compared between the two groups.The International Knee Documentation Committee(IKDC)and Lysholm scoring system were used to comprehensively evaluate clinical efficacy.RESULTS Eighty patients were followed for 24-36 mo,with an average follow-up duration of 27.5±1.8 mo.There were no significant differences in the time between surgery and injury,operative duration,IKDC and Lysholm scores of the affected knee at the last follow-up evaluation between the two groups.There were significant differences in VAS scores 1 d,3 d,7 d,2 wk and 1 mo after surgery(P<0.05).There was no significant difference in VAS score at 3 mo,6 mo and 1 year after operation.CONCLUSION The efficacy of the AIST ACL reconstruction technique was comparable to the TBT technique,but the postoperative pain was less with the AIST technique.Thus,the AIST technique is an ideal treatment choice for ACL reconstruction.

Graft choices for anterolateral ligament knee reconstruction surgery: Current concepts

The anterolateral ligament(ALL)is a primary structure of the anterolateral complex of the knee that contributes to internal rotational stability of the joint.Injury of the ALL is commonly associated with rupture of the anterior cruciate ligament.If left untreated,ALL lesions may lead to residual anterolateral rotational instability of the knee after anterior cruciate ligament reconstruction,which is a common cause of anterior cruciate ligament graft failure.The function of the ALL can be restored by lateral extraarticular tenodesis or anterolateral ligament reconstruction(ALLR).In the lateral extraarticular tenodesis procedure,a strip of the iliotibial band is placed in a non-anatomical position to restrain the internal rotation of the tibia,while in ALLR,a free graft is fixed at the insertion points of the native ALL.Gracilis and semitendinosus grafts have mainly been utilized for ALLR,but other autografts have also been suggested.Furthermore,allografts and synthetic grafts have been applied to minimize donor-site morbidity and maximize the size and strength of the graft.Nevertheless,there has been no strong evidence to fully support one method over another thus far.The present review presents a detailed description of the graft choices for ALLR and the current literature available in regard to the effectiveness and outcomes of published surgical techniques.

Relationship between tunnel widening and different rehabilitation procedures after anterior cruciate ligament reconstruction with quadrupled hamstring tendons

Background It has been demonstrated that bone tunnel widening could appear after knee anterior cruciate ligament (ACL) reconstruction, especially for those patients whose ruptured ACL were reconstructed with semitendinosus and gracilis tendons. Many factors can influence the extent of tunnel widening. Few studies have investigated the relationship between bone tunnel widening and rehabilitation procedures. This research was carried out to find the rehabilitation procedures' influence on the tibial bone tunnel widening after ACL reconstruction. Methods Sixty-five cases, whose ACL reconstructions were done using quadrupled semitendinosus and gracilis tendons, were divided into two groups. Group A had 33 cases, 19 men, 14 women, averaged (31.2±12.4) years old, only ACL reconstruction was done using Paessler's technique, and aggressive rehabilitation procedure was used for function recovery post operation. Group B had 32 cases, 20 men, 12 women, averaged (30.3±10.3) years old. Except for ACL reconstruction, every patient in group B accepted meniscus repair using re-fixation methods or cartilage repair using microfracture technique, conservative rehabilitation procedure was used post operation. Six months post operation, standard posterior-anterior radiographic plates were taken for each case, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification effect of X-ray plates was taken out after measurement. Results Six months after ACL reconstruction the tibial tunnel widening of the upper, middle and lower parts on both the posterior-anterior and lateral X-ray plates in Group A with aggressive rehabilitation procedure was much more serious than in Group B with conservative rehabilitation. KT-1000 knee stability measurement and clinical manifestation showed no difference between the two groups. Conclusions Rehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It not only can directly influence the function recovery of ACL reconstructed knee, but also perhaps indirectly influence the function recovery and long-term clinical result of the operated knee by influencing the tunnel widening.

Clinical evaluation of double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts： a prospective, randomized and controlled study

Background In clinical studies there is still a lot of controversy about the increased anterior and rotational stability between double-bundle （DB） and single-bundle （SB） anterior cruciate ligament （ACL） reconstruction. The aim of this study was to evaluate the clinical results of four-tunnel DB ACL reconstruction.Methods Sixty-four consecutive patients with ACL ruptures from May 2005 to May 2006 were randomly assigned into two groups： 32 cases for SB ACL reconstruction and 32 cases for DB ACL reconstruction. Clinical data, including KT 2000, Biodex test, Lysholm score, Tegner score and IKDC score, were prospectively collected until at least 10 months post-operative.Results The average values of KT 2000 were （1.47±1.17） mm and （1.68±1.14） mm for the SB and DB ACL reconstruction groups at 30° of knee flexion （P 〉0.05）, and were （1.04±0.98） mm and （1.13±0.98） mm at 90° of knee flexion （P 〉0.05）. There were also no significant differences in Lysholm score, Tegner score, IKDC score and Biodex test scores between the two groups （P 〉0.05）. The operation time of DB ACL reconstruction was 20 minutes longer than the SB ACL reconstruction （P 〈0.05）Conclusion Double bundle ACL reconstructions have no obvious clinical advantages over single bundle ACL reconstructions.

Implantless patellar fixation in medial patellofemoral ligament reconstruction

Purpose:The medial patellofemoral ligament(MPFL)acts as primary restraint to lateral patellar dislocation and its rupture has been reported in almost all cases of acute patellar dislocation.Various surgical techniques have been described for MPFL reconstruction,using many femoral and patellar fixation techniques and different grafts.This article details our technique for MPFL reconstruction using semitendinosus graft which avoids the use of implant at patellar end.Methods:Twenty patients(8 males and 12 females)with complaints regarding acute and chronic lateral patellar instability were evaluated and treated by MPFL reconstruction procedure.The mean age of patients was 21 years(range 17-34 years).MPFL reconstruction was performed using semitendinosus graft passing through two parallel,obliquely directed tunnels created in patella.Fixation of graft was done with an interference screw only at the femoral end.Mean follow-up period after intervention was 26.4 months(range 23-30 months).Results were evaluated using Kujala score.Results:All patients gained adequate patellar stability and full arc of motion.No incidence of patella fracture was noted.There were no postoperative complications related to the procedure.There was no recurrence of instability in patella at final follow-up.Conclusion:Passing the graft through the tunnels in patella without use of any implant has given excellent functional outcome and moreover has the advantages of less implant-related complications and cost-effectiveness.

Reconstruction of the medial patellofemoral ligament with a suture-tie technique of patellar side fixation

Background Medial patellofemoral ligament （MPFL） reconstruction is the preferred operative treatment for recurrent patellar dislocation. The purpose of this study was to report a novel suture-tie technique of patellar side fixation in medial patellofemoral ligament reconstruction for recurrent patellar dislocation, and to evaluate the intermediate-term results. Methods We retrospectively reviewed the results of 22 MPFL reconstructions in 21 patients （6 male and 15 female） with a suture-tie technique performed by a single surgeon between March 2004 and July 2009. All patients had been diagnosed with recurrent patellar dislocation. Outcomes were assessed preoperatively and postoperatively by physical and radiographic examination as well as with Kujala and Lysholm scores. Results At the mean follow-up month 37.5 （range： 24-56 months）, there was no graft failure. Primary healing was achieved in all cases. At the final follow-up, the mean Kujala score improved from 53.9 （range： 46-62 points） to 84.1 （range： 78-90 points） postoperatively （P 〈0.05）, and the mean Lysholm score improved from 47.2 points （range： 37-57 points） to 82.8 points （range： 76-89 points） postoperatively （P 〈0.05）. To date, no patients have reported redislocation or subluxation; however, there is one patient with a positive apprehension test. Conclusion A suture-tie technique in medial patellofemoral ligament reconstruction can restore patella stability without significant complication.