S. Pujol N, Colombet P, Potel JF, Cucurulo T, Graveleau N, Hulet C, Panisset JC, Servien E, Sonnery-Cottet B, Trojani C, et al. Among 153 AIT-ACLR patients, 145 (94.77%) had a normal pivot shift test, while eight (5.22%) had positive tests. As the term repair suggests the injured or torn ligament is rejoined surgically, it involves repairing the torn ligament with sutures. PRISMA Flowchart of included articles regarding all-inside and transportal anterior cruciate ligament reconstruction. Maestro A, Surez-Surez MA, Rodrguez-Lpez L, Villa-Vigil A. Knee Surg Sports Traumatol Arthrosc. 2017;24(4):70510. Knee Surg Sports Traumatol Arthrosc. Google Scholar. A systematic literature review, using PRISMA guidelines, was conducted using PubMed, Medline, Google Scholar, and EMBASE, up to February 2021 to identify studies focusing on AIT and TP techniques of ACL reconstruction. The purpose of . Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD. Musahl V, Getgood A, Neyret P, et al. Am J Sports Med. Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Short sockets have been shown to have superior tendon to bone fixation compared to standard long tunnels in a histologic canine study by Smith et al. Both procedures involve removing the damaged ACL and then either repairing or reconstructing the ACL. Moreover, creating sockets rather than full tunnels have some benefits including removing fewer bony structures which lead to less post-operative pain and inflammation, along with bone preservation in cases in which subsequent multiple ligament reconstruction is needed in the near future [21, 68, 85]. We included clinical studies involving individuals 18years old, articles written in English, and surgeries limited to primary ACLR or where ACLR was the primary purpose of the surgery. ACL repairs used to have a very high failure rate. Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides. 2014;42(12):293340. 1. Among the other advantages of this technique is that the horizontally positioning of the graft results in a decrease in rotational instability [71]. The ePub format is best viewed in the iBooks reader. CAS 2016;44(6):147581. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. Request PDF | Patellofemoral functional outcome of gracilis sparing compared to gracilis sacrificing ACL reconstruction | Introduction The hamstring is the most popular autograft used for anterior . Zhang Q, Zhang S, Li R, Liu Y, Cao X. Similarly, tunnel widening although originally a concern, has been shown to occur less often in short tunnel button fixation than interference screw fixation [21]. Sports Med Arthrosc Rev. Current techniques offer the advantages of improved cosmesis, less postoperative pain, decreased bone removal, and gracilis preservation. Acad Emerg Med. Strategies to improve anterior cruciate ligament healing and graft placement. As technology and advancements in medicine occur, new solutions can overcome past challenges. Furthermore, hyperflexion requires an assistant, thus entails for improving and developing better techniques [18]. ACL repair involves repairing the torn ligament with sutures. Int J Orthop. Some studies highlight that a simple ACL reconstruction can control the translational instability, but is not able to functionally restore completely normal knee rotational stability. Monaco E, Fabbri M, Redler A, Gaj E, De Carli A, Argento G, Saithna A, Ferretti A. Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation. Patients who underwent an all inside repair had a >2-fold higher failure rate compared with patients who underwent suture hook repair through a . A total of 923 patients underwent AIT and 1678 patients underwent the TP technique for ACLR. 2011 Nov;39(11):2476-83. doi: 10.1177/0363546511402662. Bedi A, Raphael B, Maderazo A, Pavlov H, Williams RJ III. Silva A, Sampaio R, Pinto E. ACL reconstruction: comparison between transtibial and anteromedial portal techniques. After a combined surgery, these programs are also advocated (cf link below). The ALL belongs to a larger complex of the knee, the AnteroLateral Complex (ALC), which is located on the anterior (front) and lateral part of the knee at the same level as the knee joint. lets find out. The Effects of Anterolateral Tenodesis on Tibiofemoral Contact Pressures and Kinematics. Anterior cruciate ligament (ACL) injury is common in athletes, with a female predominance [1, 2]. This is due to the surgery being less invasive. Depending on the degree of ACL injury and whether it is an early or late case there are three options: In all these three cases you can go back to the sport because there is Fiber Tape Internal Bracing. Am J Sports Med. Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. report similar results comparing both side screw vs suspensory button fixation at a shorter follow-up, in their prospective RCT [17]. No, they are different. In a late case and complete ACL tear, doctors opt to do ACL reconstruction with Fibertape Internal Bracing. All-Inside ACL Reconstruction Using Retrograde Reaming Feat. Patients who come across ACL injuries are highly recommended to consider this surgery (If the doctor advises after proper diagnosis). ACL repair and reconstruction have different procedure Dr. Daggett was an early adopter to the re-discovery of ACL repair. Anterior cruciate ligament rupture: differences between males and females. But a relatively new technique does away with the graft and speeds up the healing process. Transportal versus all-inside techniques of anterior cruciate ligament reconstruction: a systematic review. Our primary hypothesis was that AIT is a superior ACLR technique compared to TP, therefore, in this review, we aimed to evaluate the available data in the literature in terms of outcome and complications of these two techniques to propose recommendations for future application. 2013;41(11):251220. However, this is only possible when the ligament is repairable, i.e if the MRI suggest that the ligament is a partial tear or high-grade partial tear. https://doi.org/10.1055/s-0040-1710521. eCollection 2017 Jun. Furthermore, the pooled complication rates from all studies were similar between the two groups (AIT: 54 patients, 8.26% vs. PT: 55 patients, 6.62%). ACL Reconstruction Rationale for Anteromedial Femoral Tunnel Approach Feat. Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Noh JH, Roh YH, Yang BG, Yi SR, Lee SY. However, there is an ongoing debate over which procedure is superior. Advantages and disadvantages of transtibial, anteromedial portal, and outside-in femoral tunnel drilling in single-bundle anterior cruciate ligament reconstruction: a systematic review. In addition, it allows for greater graft versatility and can serve as a bailout plan in case short tendons are encounteredor physeal-sparing procedures are required. Like many sports medicine surgeons, our team is passionate about preventing ACL injuries and improving the outcomes after ACL surgery, as evidenced by our participation in the SANTI ACL Research Network Study. J Orthop Traumatol Off J Ital Soc Orthop Traumatol. Anatomic double-bundle reconstruction techniques result in graft obliquities that closely mimic the native anterior cruciate ligament anatomy. Patients with previous ACL surgery or multiligamentous instability were excluded. Nevertheless, AIT-ACLR is also accompanied by some disadvantages. 2013;5(3):1358. This very strong suture device is used to repair the native ACL and restore knee stability. 2017 Mar 19;14 (2):241-246. doi: 10.1016/j.jor.2017.03.002. PubMed There have been however concerns regarding various possible modes of premature failure. George Kyriakopoulos, Spyros Manthas, [], and Konstantinos Kateros. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Graft lengthening, especially using the adjustable loop buttons has been a concern. Yasen SK, Borton ZM, Eyre-Brook AI, Palmer HC, Cotterill ST, Risebury MJ, Wilson AJ. Iriuchishima T, Goto B. Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW. The literature review did not identify a significant difference in post-operative functional outcomes between AIT and TP group. Rupture of the anterior cruciate ligament (ACL) represents an overwhelming insult sustained by the knee via contact and/or noncontact mechanisms, with a high incidence seen in contact sports, especially when patients partake in high-impact landing and twisting athletic events.1, 2, 3 ACL injuries impact patients financially in terms of the cost of operative management and postoperative . 5 criteria to be met after ACL surgery to initiate running, good physiotherapy and rehabilitation program, ulfil these 5 criteria to initiate running, 7 Easy Chronic Back Pain Exercises That Actually Work, 6 Easy Greater Tuberosity Fracture Rehabilitation Exercises, Follow These 7 Easy Low Back Pain Stretches That Actually Work, 8 Effective IT Bands Stretch to Get Back to Field Early, 9 Best Exercise for Shoulders to Fix stiff, painful shoulder, Shoe Inserts for Flat Feet: Types & How it Work, Physiofirst Physiotherapy Centre, Rourkela. Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel. Which has his success or failure rate? However, there are some differences between the two procedures. 2022 BioMed Central Ltd unless otherwise stated. The anterolateral ligament: Anatomic implications for its reconstruction. However, post-operative VAS pain scores and complications rates was lower AIT group compared to the TP group in studies directly comparing the two techniques prospectively, suggesting AIT as a good alternative method, especially when treating athletes with ACL injury. 2016;32(2):3327. Arthrosc J Arthrosc Relat Surg. Visual pain analog was recorded preoperatively and during both the immediate postoperative period and throughout the follow-up. [67] reported a superior knee flexion strength in those who underwent all-inside surgery compared to the conventional group. However, in a complete ligament tear, even if it is not completely repairable, then doctors opt for ACL augmentation. Iowa forward Shateah Wetering dribbles the ball during an Iowa women's basketball practice at Carver-Hawkeye Arena in Iowa City on Friday, July 29, 2022. Neven E, DHooghe P, Bellemans J. Double-bundle anterior cruciate ligament reconstruction: a cadaveric study on the posterolateral tunnel position and safety of the lateral structures. doi:10.1016/j.eats.2016.01.032. 2008;16(9):81822. The groups were demographically matched, with no significant differences in age and sex composition (Table (Table11). Robin et al. There is growing evidence that adding a procedure to tighten and help stabilise the outer aspect of the knee reduces the risk of re-rupture, particularly in these higher level athletes. The classic S-G group is in blue and the all-inside group in green. However, there is an ongoing debate over which procedure is superior. In the all-inside group, a single semitendinosus tendon was harvested from an anteromedial incision. 1). After ACL repair your knee feels very confident. Gobbi A. Anterior cruciate ligament reconstruction, International knee documentation committee, Knee injury and osteoarthritis outcome score. Mayr R, Heinrichs CH, Eichinger M, Smekal V, Schmoelz W, Attal R. Intraoperative workflow for all-inside anterior cruciate ligament reconstruction: an invitro biomechanical evaluation of preconditioning and knot tying. The overall perspective was that there is no significant difference regarding pre-operation and post-operation scores in both AIT and TP ACLR techniques, except regarding the VAS pain score [66,67,68,69]. Since the future trend in orthopedic surgery is toward less invasive and patients satisfaction with good outcomes, AIT is a good alternative method considering preserving bony tissue and gracilis tendon with less post-operative pain, along with more knee flexor strength and equal outcomes compared to conventional surgery. The absolute reduction in PA translation did not differ significantly between groups and neither did the postoperative values (Figure (Figure33). All-inside anterior cruciate ligament reconstruction as a salvage for small or attenuated hamstring grafts. Wilson AJ, Yasen SK, Nancoo T, Stannard R, Smith JO, Logan JS. 6). Our review was limited to articles in the English language and focused on prospective clinical trials in order to decrease the chance of bias. Lubowitz JH. Donor site morbidity has been shown to be reduced both in terms of anterior knee pain compared to BPTB graft [25,26] and overall VAS pain scores compared to S-G harvest [11]. CONMED's Infinity Knee System provides all the tools . Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. Lastly, the analysis was not performed in a blinded fashion, and data in some studies were missing. 2017;45(11):2595-2603. doi:10.1177/0363546517707961. This way your nerve fibres and blood vessels remain safe resulting in the almost natural healing of the repaired ACL. In primary repair, your torn ACL is repaired and the repair is protected by Fiber Tape Internal Bracing. In revision surgery, the addition of an extra-articular procedure is commonly considered in the setting of a revision ACL reconstruction 20. Knee ligament reconstruction has a high risk of developing knee arthritis as compared to ligament repair. if your ACL is not repairable, i.e MRI says that theres a complete ACL tear then the doctors will completely remove your old ACL and reconstructs it by taking out a graft from the hamstring tendon. Monaco E, Bachmaier S, Fabbri M, Lanzetti RM, Wijdicks CA, Ferretti A. Intraoperative workflow for all-inside anterior cruciate ligament reconstruction: an in vitro biomechanical evaluation of preconditioning and knot tying. 2014;4(1):95. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. ACL reconstruction vs repair. Kouloumentas P, Kavroudakis E, Charalampidis E, Kavroudakis D, Triantafyllopoulos GK. The type of graft was mentioned in 815 patients; in 664 (81.47%) patients semitendinosus tendon was used. (ALL, anterolateral ligament; FCL, fibular collateral ligament; GT, lateral gastrocnemius tendon; ITB, iliotibial band; LE, lateral epicondyle; PLT, popliteus tendon. Karikis I, Ahldn M, Casut A, Sernert N, Kartus J. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. It uses sockets in a half-way tunnel rather than full tunnels, resulting in a reduction in the post-operative pain, swelling, and likelihood of synovial fluid flow or infiltration among the space between the graft and the bone interface [20, 21]. Yamazaki S, Yasuda K, Tomita F, Minami A, Tohyama H. ACL graft and contralateral ACL tear risk within ten years following reconstruction: a systematic review. Bradley JP, Tejwani SG. Lubowitz JH, Schwartzberg R, Smith P. Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction. All-Inside Meniscal Repair Solution . AIT has been acclaimed to be an alternative to the TP technique [19]. The male to female ratio in these studies were 82:61 and 79:62 for AIT and TP, respectively. The first type of anterolateral extra-articular procedure developed was the Lateral Extra-articular Tenodesis (LET). A systematic review of the literature. Disagreements on including or excluding the papers or interpreting the outcomes of the studies were discussed among the reviewers and resolved. The ACL study group was organized 25 years ago by a small group of orthopedic surgeons with a common interest in the anterior cruciate ligament. The first challenge is to identify a combined ACL and ALC injury in order to define clear indication criteria for a combined procedure. Knee anatomy: http://www.aclstudygroup.com/knee-anatomy.php, ACL injury and treatment: http://www.aclstudygroup.com/acl-tear.php https://www.orthoinfo.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/ http://www.orthoguidelines.org/topic?id=1018, ACL injury prevention programs: http://www.aclstudygroup.com/the-importance-of-preventing-re-injury-after-acl-surgery.php, ALL reconstruction: https://www.arthrex.com/resources/animation/0TnmTwEvkk-k5AFNJILkdA/anterolateral-ligament-reconstruction, Lateral Extra-articular Tenodesis (LET): https://www.youtube.com/watch?v=XKfEM2oK4gU. The less invasive nature of the technique is probably the reason for this difference. Jones PE, Schuett DJ. The Lysholm knee score was used comparing the preoperative and 24-month timepoints. J Anat. 2010;34(5):74754. Contemporary anterior cruciate ligament outcomes: does technique really matter? The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. There have been however concerns regarding various possible modes of premature failure. However, the four studies that prospectively compared AIT and TP techniques showed lesser complications in the AIT group than the TP group. With 25+ years of specialized expertise in orthopedic sports medicine, Dr. Karas has published research on ACL injuries and regularly performs the anatomic "all inside" ACL reconstruction . The difficulty of seating the endoscopic aimer and maintaining the aimer in a hyper-flexed knee is a frequent criticism of the TP technique. To answer this question, it is important to differentiate between a primary ACL reconstruction surgery and a revision ACL reconstruction surgery. A revision surgery is a procedure performed on the same knee when the first surgery has failed (rupture of the ACL graft). Written and edited by world leaders in hamstring, allograft, and bone-patellar tendon-bone (BTB) ACL reconstruction, Cavaignac E, Marot V, Faruch M, et al. Am J Sports Med. In this procedure, the surgeon tries to repair torn knee ligament as much as possible and also construct another ACL from the hamstring tendon. No infections were noted or other serious adverse events. While prior studies have demonstrated the utility of AIT and TP technique, fewer have elucidated superiority of one technique over the other in terms of clinical outcome [24]. 1a). Sports Med Arthrosc Rehabil Ther Technol. 2015;23(12):347381. 2010;38(10):198796. Since the advent of Fiber Tape Internal Bracing, ACL primary repair surgeries have increased all over the world. Recommendations for return to sport vary between surgeons, but is usually planned for approximately 9 months postoperatively, to allow the grafts to properly heal and to enable restoration of sufficient strength and balance to protect from reinjury. In blue are the scores of the classic S-G group and in green are the scores of the all-inside group. 2018;31(10):102230. All-inside technique is considered as a new minimally invasive option for ACLR. The most common way of having an ACL reconstruction in Singapore involves sacrificing two tendons from one's inner thigh to replace the torn ACL. 2013;29(7):1195200. Knee. Furthermore, the anatomical positioning of the femoral tunnel in the TP technique has resulted in improved stability based on biomechanical and clinical studies; however, the long-term clinical results and ACLR failure are still a matter of debate [18, 46, 73,74,75]. Suspensory versus interference screw fixation for arthroscopic anterior cruciate ligament reconstruction in a translational large-animal model. Some ligaments have the potential to heal without surgical intervention. 2012;98(8 Suppl):S171-177. The minimum follow-up was set at 36 months. 2011;27(3):38090. Effects of additional gracilis tendon harvest on muscle torque, motor coordination, and knee laxity in ACL reconstruction. Muscle recovery after ACL reconstruction with 4-strand semitendinosus graft harvested through either a posterior or anterior incision: a preliminary study. The reviewers independently assessed the quality of included studies using the Coleman Methodology Score (CMS) [25]. Anterolateral Ligament Reconstruction Techniques, Biomechanics, and Clinical Outcomes: A Systematic Review. Lubowic et al. In fact, Ohori et al. 2018;46(3):607-616. doi:10.1177/0363546517745268. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Turk J Med Sci. Moreover, for this review, the commonly used PubMed, Medline, Google Scholar, and EMBASE databases were searched. Eur J Orthop Surg Traumatol. Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BHB, Murphy CG, Claes S. Outcome of a Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Technique With a Minimum 2-Year Follow-up. Both these two procedures may be performed in combination with ACL reconstruction. Worksheet for data extraction of reviewed literature regarding anterior cruciate ligament reconstruction techniques. Orthopedic surgeons have recently investigated options to repair a partially torn ACL. Volpi P, Bait C, Cervellin M, Denti M, Prospero E, Morenghi E, Quaglia A. AIT is a superior ACLR technique compared to TP. Figure 3. Among the fixation techniques, suspensory fixation was a preferred choice as reported in 821 patients (Table 1). Either ACL repair with Fiber Tape Internal Bracing procedure is performed for partial ligament tear. The optimal outcome scoring system for evaluating the outcome of ACLR is still a controversial issue, in which various subjective or objective scoring methods such as IKDC, Lysholm, KSS, SF-12, KOOS, and VAS scoring systems were used among the studies. Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides. The technique entails short tunnels and the use of quadrupled semitendinosus graft with dual suspensory fixation. Acta Cir Bras. The keywords used in this study were based on MeSH terms and included anterior cruciate ligament reconstruction, and similar phrases (Additional file 1: Table S1). No-tunnel anterior cruciate ligament reconstruction: the transtibial all-inside technique. 1998;6(1):S135. Sanders TL, Pareek A, Hewett TE, Levy BA, Dahm DL, Stuart MJ, Krych AJ. 2012;28(4):52631. The average age in the groups were 27.7310.32years and 29.189.65years for AIT and TP, respectively and the average BMI in the AIT groups was 25.85.05kg/m2 and in the TP group was 24.292.74kg/m2. We are experimenting with display styles that make it easier to read articles in PMC. Liu A, Sun M, Ma C, Chen Y, Xue X, Guo P, Shi Z, Yan S. Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction. Anterolateral Knee Extra-articular Stabilizers: A Robotic Study Comparing Anterolateral Ligament Reconstruction and Modified Lemaire Lateral Extra-articular Tenodesis. Adaptation and learning new surgery techniques is always time-consuming and requires practice as some techniques such as graft preparation, fixation, and socket creation involves going through applicable learning courses [22, 83]. J Orthop. At the end there is a section for medical professionals along with references for further reading. All-inside ACL reconstruction surgery is a modified and advanced surgical technique to treat ACL tears or sprains. Spragg L, Chen J, Mirzayan R, Love R, Maletis G. The effect of autologous hamstring graft diameter on the likelihood for revision of anterior cruciate ligament reconstruction. In addition, one study used a quadruple bundle for ACLR [67] while another study used a double bundle for ACLR [68]. Further comparison and randomized controlled studies with more patients are warranted to evaluate the clinical outcomes and complications of the reported methods. Clinico-radiological outcomes following anatomical anterior cruciate ligament reconstruction using the TransLateral, all-inside technique. Modified transtibial versus anteromedial portal techniques for anterior cruciate ligament reconstruction, a comparative study. Am J Sports Med. Am J Sports Med. The first group was the all-inside group and the second was the classic AM portal with S-G graft. Lui P, Zhang P, Chan K, Qin L. The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon. Our findings are similar with equivalent mechanical testing and clinical outcomes at the one-year follow-up and similar failure rates at two years between the all-inside and the full tibial tunnel group. After excluding 12,554 duplicates, a systematic screening process ultimately yielded 44 articles, 15 full-text articles regarding AIT [26,27,28,29,30,31,32,33,34,35,36,37,38,39,40], 25 regarding TP technique [41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65], and four [66,67,68,69] articles regarding AIT versus TP technique which were included in this review (Fig. A capsular bony avulsion (pull off) of the ALC, also called a Segond fracture, is virtually always associated with an ACL tear 3. Second, it allows the surgeon to perform additional procedures at the same time, such as meniscus repair or cartilage restoration. Chalmers PN, Mall NA, Yanke AB, Bach BR Jr. Contrastingly, the VAS pain score was significantly lower in the AIT group compared to the TP group. This is what we call primary ACL repair and its results are the best. The ACL is reconstructed using a piece of tissue taken from another part of your body (autograft) and used to create a new ligament. Otsubo H, Shino K, Nakamura N, Nakata K, Nakagawa S, Koyanagi M. Arthroscopic evaluation of ACL grafts reconstructed with the anatomical two-bundle technique using hamstring tendon autograft. The literature also reveals that the addition of LET to an ACL reconstruction does not provide clear additional benefit in controlling rotation in early primary reconstructions (12 months), but is effective in reducing the postoperative ALRI in a delayed reconstruction 7. Among four studies, two of them used allograft [67, 68] for both techniques while the remaining two used autografts [66, 69]. Development and application of an inside-to-out drill bit for anterior cruciate ligament reconstruction. 2013;21(1):4150. Arthrosc J Arthrosc Relat Surg. A single semitendinosus graft was commonly used in the AIT compard to combined semitendinosus and gracilis graft in the TP group. Google Scholar. Compared to isolated ACL reconstruction, the postoperative discharge instructions after an LET or an ALL reconstruction are essentially the same. The initial search yielded a total of 36,859 articles. Chen CH. Reprinted with permission from Dr Rob LaPrade (Dephillipo et al. https://doi.org/10.1186/s13018-021-02872-x, DOI: https://doi.org/10.1186/s13018-021-02872-x. All-Inside ACL Reconstruction. 2013;29(8):13307. Furthermore, when compared to the preoperative score at two years follow-up, the postoperative Lysholm score increased by 37.13 and 27.99 points in the AIT and TP groups, respectively. California Privacy Statement, Our primary hypothesis was that AIT is a superior ACLR technique compared to TP. However, AIT is associated with learning curve and increased risk of injuring extra-articular surface. Thromboprophylaxis was used as per national protocols and simple range of motion and strengthening exercises were instructed for the first two weeks. 2019;27(1):1249. J Clin Orthop Trauma. Therefore, the concept of combining a lateral extra-articular procedure with an intra-articular reconstruction for the treatment of ACL injury emerged, with the objective of addressing potential ALRI of the knee and decreasing the failure rate after an ACL reconstruction carried out in isolation 8. doi:10.1016/j.eats.2015.02.006. 2006;22(8):900.e901-900.e911. 2012;40(3):51220. We excluded animal experiments, cadaveric studies, retrospective studies, case reports, technical notes, and studies without quantitative data. Eccentric graft positioning within the femoral tunnel aperture in anatomic double-bundle anterior cruciate ligament reconstruction using the transportal and outside-in techniques. Our ligaments, including ACL and PCL knee ligaments, have a natural supply of nerve fibres and blood vessels which is very important for the nourishment of ligament and joint cartilage. Chahla J, Menge TJ, Mitchell JJ, Dean CS, LaPrade RF. J Orthop Surg Res 16, 734 (2021). Am J Sports Med. Sports Med Arthrosc Rev. In primary repair, your old torn ACL is completely repaired, without the need for a hamstring tendons graft. (FCL, fibular collateral ligament; PFL, popliteofibular ligament.) While both procedures offer similar outcomes, each comes with its own set of pros and cons. Oper Tech Sports Med. Clin Sports Med. Morgan G. All-inside ACL reconstruction. 2004;20(3):32830. Consequently, during a rotational injury of the knee, the ALC is frequently injured. There was a total of 11,867 patients who underwent ACL reconstruction for an isolated diagnosis of ACL tear. Inderhaug E, Stephen JM, El-Daou H, Williams A, Amis AA. Which is right for you? Knee. Button fixation, especially on the femoral side, has been well established and has shown equivalent long-term outcomes with screw fixation with both hamstring and patellar tendon grafts in one of the longest follow-up studies in the literature[16]. The four studies that directly compare AIT and TP techniques [66,67,68,69], on the other hand, showed that three patients in the AIT group had post-operative complications such as ACL failure (n=1), septic arthritis (n=1), and cyclops syndrome (n=1). Femoral Origin of the Anterolateral Ligament: An Anatomic Analysis. The interference screw was the preferred fixation method used in 806 patients (52.64%) for the tibial side and 311 patients (20.31%) for the femoral side (Table 2). If repair may be an option for the patient during surgery, this is discussed during the pre-operative visit. In short, an ALL reconstruction involves fixing a free graft (commonly a hamstring tendon) between the tibia and the femur in the same location as the native ALL. It seems, therefore, that it is the unsupported tendon length that can freely move in the tunnel and not the fixation method that is the main factor leading to tibial tunnel widening. Unfortunately, the anterior cruciate ligament (ACL) injury is among the most common orthopedic injuries, especially for youth athletes. in a review reported other shortcomings of TP technique such as difficulty visualizing in hyperflexion possibly leading to iatrogenic chondral injury, technically demanding, short or bicortical socketswhich may limit fixation options, higher revision rate, increased risk of injury to the common peroneal nerve, andextension loss during stance phase [18]. When your ACL is torn, there are two main types of ACL surgery: ACL repair and ACL reconstruction. 2009;25(1):95101. Whatever the technique used, an LET usually involves fixing a part of the ITB to the femur just above the knee joint. [18] report a 6.5% failure rate at the three-year to follow up which they attribute mostly to violent episodes/re-injury. Basdekis G, Abisafi C, Christel P. Influence of knee flexion angle on femoral tunnel characteristics when drilled through the anteromedial portal during anterior cruciate ligament reconstruction. Int Orthop. Biomechanical Comparison of Anterolateral Procedures Combined With Anterior Cruciate Ligament Reconstruction. In an ACL repair situation, the native ACL is repaired using sutures. Claes S, Verdonk P, Forsyth R, Bellemans J. All-Inside Meniscal Repair Utilizing a Flexible Needle . Marchant BG, Noyes FR, Barber-Westin SD, Fleckenstein C. Prevalence of nonanatomical graft placement in a series of failed anterior cruciate ligament reconstructions. The Anterior Cruciate Ligament Study Group (ACL). Anatomic all-inside anterior cruciate ligament reconstruction using the translateral technique. 2017;14(3):A1. Overall, all-inside ACL reconstruction has been shown to have equivalent outcomes to classic S-G and BPTB reconstruction at mid-term follow-up [6,11,17,18,23]. Reconstruction and Basic Science, 2nd Edition, by Dr. Chadwick Prodromos, provides the expert guidance you need to effectively select the right procedure and equipment, prevent complications, and improve outcomes for every patient. Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Rezazadeh S, Ettehadi H, Vosoughi AR. The pooled data from all the studies showed that the similar complication rates in AIT and TP techniques (8.26 percent vs. 6.62 percent, respectively) with graft failure, ACL failure, and paresthesia being the most common complications (Table 3). as evidenced by our participation in the SANTI ACL Research Network Study, however, re-injury and failure of return to play can happen. Tibial tunnel enlargement after anatomic anterior cruciate ligament reconstruction with a bone-patellar tendon-bone graft. The ACLs location and environment complicate this ligaments natural healing. 2009;37(10):19129. August 2017. doi:10.1016/j.knee.2017.07.001. This can be a case where the ACL tear is on the femur bone (thigh bone), in an early case the primary repair is the preferred procedure. You need to fulfil these 5 criteria to initiate running as soon as possible. Stryker. We also found improved VAS pain scores in the all-inside group compared to the full tibial tunnel S-G group, but the difference was significant only in the early (six months) postoperative period. 2017;25(4):130715. Open Access J Sports Med. Arthroscopy. Graft selection and surgical technique during ACL reconstruction have always been a source of contention because they have a direct impact on the outcome. Kim JG, Wang JH, Lim HC, Ahn JH. K. Montgomery 02:43. Russu OM, Ciorcila E, Feier AM, Fleaca R, Zuh SG, Ioanovici AC, Gergely I. Even in the more demanding younger patients, where the failure rates have been higher [24] theall-inside technique has wielded favorable outcomes [25]. He is one of the few surgeons in Delhi NCR who practice All Inside ACL/PCL reconstruction with Fibre Tape internal bracing, in addition, has mastered regenerative medicine, cartilage transplant, knee multi-ligament surgeries, and complex shoulder surgeries. Preoperatively Lysholm, Visual analog pain scores and KT-1000 mechanical testing were performed. Conclusion: The all-inside technique appears to be equivalent in terms of outcomes to the classic S-G technique, and given the less-invasive nature and versatility in graft choices is a safe and effective technique for primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;32(6):108697. Smith PA, Stannard JP, Pfeiffer FM, Kuroki K, Bozynski CC, Cook JL. Magnussen RA, Lawrence JT, West RL, Toth AP, Taylor DC, Garrett WE. February 2017. doi:10.1007/s10195-017-0449-8. After suture removal at the two-week follow-up, formal physiotherapy was commenced coordinated by the same physiotherapist. Ultimately, the method of choice is based upon the surgeons available equipment; graft choice; experience; efficiency; patient age and activity level; and cosmesis and other relative factors. The new ACL is secured into holes drilled into the bones in the knee and fixed in place. 2020;28(2):58493. The use of various outcome measuring methods and missing data leads to the inability to perform a meta-analysis to quantify the overall outcome of the AIT versus TP technique. On the contrary, there is a lower risk of arthritis in ACL repair as the natural ligament, its nerve and blood vessel are preserved. Authors Alexander J Connaughton 1 , Andrew G Geeslin 2 , Christopher W Uggen 2 Affiliations Knee Surg Sports Traumatol Arthrosc. Methods of performing an ITB lateral tenodesis were described initially by Lemaire in 1967 (Figure 2), MacIntosh in 1972, and Ellison in 1979 as a novel way of controlling ALRI. Scopp JM, Jasper LE, Belkoff SM, Moorman CT III. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. J Knee Surg. The24-month postoperative scores for the classic group increased significantly to an average of 87 (p < 0.001), and similar results were found in the all-inside groups, with a mean Lysholm score of 86.13 (p < 0.001). Graft healing in anterior cruciate ligament reconstruction. ACL repair offers some advantages over ACL reconstruction. Article Femoral graft bending angle and femoral tunnel geometry of transportal and outside-in techniques in anterior cruciate ligament reconstruction: an in vivo 3-dimensional computed tomography analysis. The transportal (TP) and all-inside techniques (AIT) are the most commonly used reconstruction procedures in current clinical practice. 2011;19(5):82931. Among the other advantages are the made small incision from a cosmetic aspect [22], less invasiveness and variety of graft choices [23]. The less-invasive nature of the technique with single tendon harvest and short tibial and femoral tunnels allows for improved early outcomes and does not burn any bridges for possible future revision surgery. Am J Sports Med. As much as the benefit of LET for revision surgery is amply proven, its use in primary surgery remains somewhat controversial, and the indications are still therefore being defined 7. Given that the AIT requires quadrupled semitendinosus tendon, it was demonstrated in our review to achieve adequate graft length and thickness. B. Balldin 11:18. The classic group underwent hamstring ACL reconstruction using both gracilis and semitendinosus tendons harvested through an anteromedial incision. Arthrosc J Arthrosc Relat Surg. He has given lectures in various orthopedic and sports medicine conferences. 13 Jun. A retrospective comparative study. The Role of Lateral Extra-articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis and Best-Evidence Synthesis. The postoperative increase in International Knee Documentation Committee (IKDC), Lysholm, KT-1000, and Short Form-12 (physical and mental) scores were similar in the AIT group and the TP group. All tests were two-sided, statistical significance was set at p < 0.05. ACL tears, reconstruction, and year-long rehabilitation can take a large physical and emotional toll on student-athletes. The ALL tightens when the knee is internally rotated (twisted inwards) and in doing so provides rotational stability of the knee 18. 2019;11:S32631. The average length and the diameter of grafts used were 63.583.69 and 8.270.65, respectively. Both groups showed a significant (p < 0.005) decrease in pain levels between the preoperative and the six- and 24-week time-points, with the all-inside groups showing a significant decrease in pain in all postoperative time points (Figure (Figure22). Anterolateral knee biomechanics. Kumar C, Gupta AK, Singh SK, Jain R. Transportal anterior cruciate ligament reconstruction with quadrupled hamstring tendon graft: a prospective outcome study. Hamstring graft incorporation according to the length of the graft inside tunnels. Since there were no readily available criteria for anatomic ACLR, we have chosen to include all articles in which the authors stated that the reconstructive surgical procedure they performed was the AIT or TP techniques, or that the described technique used in their study indicated the use of AIT or TP. Epub 2011 Apr 22. Robin BN, Jani SS, Marvil SC, Reid JB, Schillhammer CK, Lubowitz JH. Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee. Preoperative versus postoperative Lysholm scores between groups as well as the percentile change were compared using independent samples t-test. Combined Intra- and Extra-articular Reconstruction of the Anterior Cruciate Ligament: The Reconstruction of the Knee Anterolateral Ligament. No financial support was received for this study. 2015;31(9):17339. Magnussen RA, Meschbach NT, Kaeding CC, Wright RW, Spindler KP. Upcoming meeting St Kitts Jan 29th Feb 2nd 2023 (Postponed from 2022), Thomas Neri and David A PARKER, Sydney Orthopaedic Research Institute, Sydney, Australia. acl, tibial interference screw, suspensory fixation, semitendinosus and gracilis graft, quadrupled semitendinosus, all-inside, anterior cruciate ligament (acl) reconstruction. Fax: (816) 525-2841. However, some studies have demonstrated that this procedure can over-constrain the lateral tibiofemoral compartment with a risk of postoperative stiffness 8,12,13. Clin Orthop Relat Res. 2000;10(1):211. Arthroscopy. Song E-K, Kim S-K, Lim H-A, Seon J-K. In reconstruction surgery, the surgeon completely removes the torn ligament and replaces it with a tendon graft from the hamstring tendon. 2018;7(5):e4537. At the three-year mark, there were no failures in either of the groups. Moreover, technically challenging short or bicortical sockets, which can limit fixation options, possible damage to the articular cartilage, increased risk of injury to the common peroneal nerve, posterior-wall blowout, increased revision rate, and extension loss during the stance phase are among the other weaknesses of the TP technique that can affect the clinical outcome after ACLR [18, 53, 65, 76, 77]. 2015;43(7):1598-1605. doi:10.1177/0363546515571571. However, a caveat to this technique is that it may result in disproportionate stress on the graft which increases the possibility of graft failure, rupture of the femoral posterior wall, and short femoral tunnel length [10, 12,13,14,15,16,17]. 2013;223(4):321-328. doi:10.1111/joa.12087. [10]. Orthop Traumatol Surg Res. Where your ACL is completely healed, tendons need not be removed. DePhillipo NN, Cinque ME, Chahla J, Geeslin AG, LaPrade RF. Br J Sports Med. Am J Sports Med. Reprinted with permission from Dr Rob LaPrade (Slette et al. However, there was no difference in narcotic drug consumption in both groups, patients who underwent AIT-ACLR surgery reported lower VAS pain scores and a more rapid decrease in pain in the following months after surgery [66, 68]. 2014;9:110. Cordasco FA, Mayer SW, Green DW. ACL repair is rarely performed by surgeons because there is frequently no blood supply for the ligament . Arthrosc J Arthrosc Relat Surg. Also, nerve fibres and blood vessels take a lot of time to develop which increases the risk of developing knee arthritis. Postoperatively no brace was used and the patients were instructed to weight-bear as tolerated on their heels. Also, articles published after the search period were not included in this review. The authors have declared that no competing interests exist. 2011;27(3):3729. Arthrosc J Arthrosc Relat Surg. The Involvement of the Anterolateral Ligament in Rotational Control of the Knee. Its nerves and vessels are intact and the chances of future arthritis are very less. Inclusion criteria were ACL reconstruction through all-inside technique or AM technique with HS or BpTB performed between January 2015 and May 2018; age between 15 and 30 year old; minimum 24 months' available follow-up. Sajovic M, Stropnik D, Skaza K. Cortical suspensory button versus aperture interference screw fixation for knee anterior cruciate ligament soft-tissue allograft: a prospective, randomized controlled trial. Suspensory versus interference screw fixation for arthroscopic anterior cruciate ligament reconstruction in a translational large-animal model. Each group comprised 22 patients. AIT-ACLR is a promising technique for reliably creating appropriately wide grafts without the requirement for allograft augmentation [86], which can be performed by harvesting a single semitendinosus graft, while also preserving the gracilis tendon. However, modifications can be applied to improve this technique which requires further comparison studies and evaluations of various grafts, fixations, drilling methods, and outcomes. The adjusted absolute difference between pre and postoperative values between groups was done using analysis of covariance model (ANCOVA). Smith PA, Schwartzberg RS, Lubowitz JH. The type of graft used was mentioned in 1541 cases, 768 (49.83%) used a combination of semitendinosus and gracilis tendons. Oper Tech Sports Med. But, ligament reconstruction altogether is a different surgical procedure. A pooling method of means and variances was utilized to calculate the overall outcome scores. Furthermore, based on the Knee Society Scoring system [40] in AIT-ACLR patients, an increase of 24.2920.27 for pain and 31.3127.17 for function during a twoyear follow-up was observed, while these measures were 20.8418.75 and 29.1626.32 for pain and function, respectively, during a one-year follow-up. Clinical outcomes of anatomic, all-inside, anterior cruciate ligament (ACL) reconstruction. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. B' Department of Orhopaedics, KAT General Hospital of Attica, Kifisia, GRC, No significant difference between groups is observed, Anterior Cruciate Ligament Reconstruction With the All-Inside Technique: Equivalent Outcomes and Failure Rate at Three-Year Follow-Up Compared to a Doubled Semitendinosus-Gracilis Graft, Monitoring Editor: Alexander Muacevic and John R Adler. Based on the reviewed literature, AIT and TP technique each has its own advantages and disadvantages; however, AIT is a suitable alternative method considering preserving bony tissue and gracilis tendon with less post-operative pain and complications, along with more knee flexor strength and equal outcomes compared to TP technique. Such results were reported by Bressy et al. One of these extra-articular structures is the AnteroLateral Ligament (ALL), which was actually first described in 1879, and recently rediscovered and widely documented 4. Bressy G, Brun V, Ferrier A, et al. The standard treatment for ACL injury is anterior cruciate ligament reconstruction (ACLR), which has evolved over time with the goal of achieving a more anatomical and less invasive reconstruction method because previous non-anatomic repairs were shown to have a higher risk of graft impingement, rotational instability, and graft attenuation [4,5,6,7,8]. Stryker. Part 2: factors related to the tibial tunnel enlargement. Comparison of the clinical outcome of double-bundle, anteromedial single-bundle, and posterolateral single-bundle anterior cruciate ligament reconstruction using hamstring tendon graft with minimum 2-year follow-up. 2021;34(14):15318. A tourniquet was used in all patients and a drain was placed, that was removed on the firstpostoperative day. Smith PA, Stannard JP, Pfeiffer FM, Kuroki K, Bozynski CC, Cook JL. The optimal ACL reconstruction is still a highly debated clinical issue in orthopaedic research. 2011;27(7):90613. Phone: (816) 525-2840 4 Indication for fibre tape internal brace technique for repair and reconstruction. 2019;101(20):181220. Finally, it is not recommended for patients who have had previous knee surgeries. Kouloumentas et al. Amirhossein Erfani. The scores from the classic S-G tibial interference screw are in blue and the all-inside group is in green. In total, 44 patients were included and sequentially allocated to either the standard or all-inside group. In a primary surgery incorporating ALL or LET, the objectives are to: 1) have better control of the ALRI and 2) decrease the risk of re-injury. July 2018. doi:10.1007/s00167-018-5072-6. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. Exclusion criteria were contralateral ACL reconstruction; need for any other associated procedures during surgery. Required fields are marked *. Copyright 2022 Physiosunit | Powered by Astra WordPress Theme, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on Pocket (Opens in new window), Click to email a link to a friend (Opens in new window), Click to share on Telegram (Opens in new window), Click to share on Skype (Opens in new window), Gans, Itai et al. All-inside anterior cruciate ligament (ACL) reconstruction has undergone a series of modifications over the past 20 years. 2016;32(12):2592-2611. doi:10.1016/j.arthro.2016.04.028. A visual analog scale (VAS) pain score was obtained at each follow-up visit, KT-1000 testing was performed at a minimum of six months postoperatively and the Lysholm score at the 24-month follow-up visit. Benea H, dAstorg H, Klouche S, Bauer T, Tomoaia G, Hardy P. Pain evaluation after all-inside anterior cruciate ligament reconstruction and short term functional results of a prospective randomized study. 2012;20(8):158493. Knee. 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