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Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3592-3598. doi: 10.1007/s00167-019-05456-9. Epub 2019 Mar 19.

Superior knee flexor strength at 2 years with all-inside short-graft anterior cruciate ligament reconstruction vs a conventional hamstring technique.

Author information

1
Orthopaedics and Sports Orthopaedics Clinic, Metropolitan Hospital, Ethnarchou Makariou 9 & El. Venizelou 1, N. Faliro, 18547, Piraeus, Greece. info@kouloumentas.gr.
2
Orthopaedics and Sports Orthopaedics Clinic, Metropolitan Hospital, Ethnarchou Makariou 9 & El. Venizelou 1, N. Faliro, 18547, Piraeus, Greece.
3
Department of Geography, University of the Aegean, Mytilene, Lesvos Island, Greece.

Abstract

PURPOSE:

To compare the "all-inside technique" for anterior cruciate ligament (ACL) reconstruction using a short, quadrupled semitendinosus tendon (ST4) autograft and suspensory cortical fixation on both the femoral and tibial side vs the "conventional technique" using a semitendinosus/gracilis (ST/G) autograft fixed with a suspensory device on the femoral side and with an interference screw on the tibial side, in terms of clinical and functional outcomes.

METHODS:

A total of 90 patients were enrolled, randomised into two groups, and prospectively followed. Group A comprised 45 patients treated with the all-inside technique and Group B included 45 patients treated with the conventional ACL technique (55 males, 35 females; mean age 28.7 ± 11.3 years). Patients completed the Lysholm knee score, the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Score (KOOS), and the Knee Society Score (KSS) preoperatively and at 2 years postoperatively. Anterior tibial translation measurement (KT-1000 arthrometer) and isokinetic testing of the operative vs non-operative limb were also conducted and the limb symmetry index (LSI) was determined.

RESULTS:

At 24 months, the Lysholm, IKDC, KOOS, and KSS scores between the two groups were similar (n.s.). Anterior tibial translation between the operative and non-operative knee was also similar among the two groups (n.s.). Patients of Group A had significantly higher mean LSIs in terms of flexor peak torque (1.0 ± 0.1 vs 0.9 ± 0.1; p < 0.001), time-to-peak (0.9 ± 0.1 vs 0.8 ± 0.1; p < 0.001) and total work (0.9 ± 0.1 vs 0.8 ± 0.1; p < 0.001) at 180°/s, and significantly better mean LSI for isometric flexor/extensor ratio at 90° (1.1 ± 0.3 vs 0.8 ± 0.2; p < 0.001).

CONCLUSION:

The all-inside ACL reconstruction with an ST4 autograft and cortical button fixation on both ends is a viable alternative to the conventional technique. It affords preservation of knee flexor strength, which is of advantage, especially when treating athletes with ACL injury.

LEVEL OF EVIDENCE:

I.

KEYWORDS:

All-inside; Anterior cruciate ligament reconstruction; Cortical button fixation; Short graft

PMID:
30888448
DOI:
10.1007/s00167-019-05456-9
[Indexed for MEDLINE]

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