All-Inside Anterior Cruciate Ligament Reconstruction —A Systematic Review of Techniques, Outcomes, and Complications

J Knee Surg DOI: 10.1055/s-0038-1627446The all-inside technique (AIT) for anterior cruciate ligament reconstruction (ACLR) is gaining popularity as a more anatomic, less invasive, technique with the potential for more rapid recovery. This systematic review aims to critically assess components of the technique, its safety profile, outcomes, and complications. PUBMED, EMBASE, and MEDLINE were searched for studies discussing primary ACLR using the AIT. Article screening, quality assessment, and data abstraction were completed in duplicate, and a minimal clinically important difference (MCID) was used to frame the descriptive results in a clinically significant context. A total of 13 studies satisfied the inclusion criteria. Five-hundred twenty six patients (mean age 31.9 ± 5.9 years) underwent ACLR using the AIT. The mean follow-up was 18.2 ± 7.7 months. Graft choice included autograft (73.8%) and allograft (26.2%). Drilling techniques for femoral sockets were outside-in (53.4%) and through the anteromedial portal (35.4%), whereas tibial sockets were drilled outside-in (35.0%) and through the superomedial portal (3.8%). The rehabilitation protocol had an immediate focus on obtaining full knee extension, jogging permitted 2 to 4 months postoperatively in 61.5% of studies, and return to cutting and pivoting sports 6 to 9 months postoperatively in 69.2% of studies. A MCID was reached for subjective International Knee Documentation Committee...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research

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ConclusionsAutograft remains the standard for ACL reconstruction in the general pediatric population. In the adolescent population, however, the use of BTB or ATB allograft is a reasonable alternative with satisfactory outcomes, decreased harvest site morbidity, decreased post-operative pain and faster rehabilitation. The traumatic re-rupture rate in this series was similar to previously published traumatic failure rates in young adult athletes after reconstruction with autologous tissue (11–13%). Further prospective studies are needed to determine any true difference in the use of either allograft or autograft in th...
Source: Journal of Orthopaedics - Category: Orthopaedics Source Type: research
ConclusionsKneeling was the most challenging activity in terms of creating considerable levels of anterior knee pain in patients who had undergone an ACL reconstruction using a BPTB graft. Other knee activities, however, did not create moderate or severe degrees of anterior knee pain. Both anterior knee pain and numbness at the proximal leg improved over time.Trial registration number: TCTR2018–0630002.
Source: Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology - Category: Sports Medicine Source Type: research
J Knee Surg DOI: 10.1055/s-0038-1669916The current review aims to compare the outcomes of anterior cruciate ligament (ACL) reconstruction in the female population after patellar–tendon–bone and hamstring grafts. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All original randomized controlled trials and prospective cohort studies that compared clinical outcomes after female ACL reconstruction using hamstring versus patellar–tendon–bone grafts were included. All clinical outcomes reported by three or more studies were included. Fiftee...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research
ConclusionsThe use of patellar tendon with closure of the paratenon in ACL reconstruction was not shown to modify patellar height within the radiological follow-up of two years.ResumenObjetivoLas complicaciones asociadas al uso de injertos del ligamento cruzado anterior (LCA) son frecuentes. Los cambios en la altura, sobre todo de la patela baja, pueden ser la razón de la aparición de dolor en la zona anterior de la rodilla. Diversos estudios han asociado la reconstrucción del LCA mediante la técnica de injerto hueso-tendón-hueso con patela baja.MétodosCuarenta y tres pacientes con...
Source: Revista Espanola de Cirugia Ortopedica y Traumatologia - Category: Orthopaedics Source Type: research
Publication date: Available online 18 August 2018Source: Orthopaedics &Traumatology: Surgery &ResearchAuthor(s): Mathieu Thaunat, Jean Marie Fayard, Bertrand Sonnery-CottetAbstractIn anterior cruciate ligament (ACL) reconstruction, success depends on several factors: patient selection; surgical technique, taking account of associated meniscal and ligamentous lesions; and postoperative rehabilitation. Improved hamstring-tendon graft preparation and fixation techniques now provide results in terms of laxity and retear comparable to patellar tendon graft, which has long been the gold-standard for patients with strong ...
Source: Orthopaedics and Traumatology: Surgery and Research - Category: Orthopaedics Source Type: research
AbstractPurposeAim of this study is to document if combined meniscal allograft transplantation (MAT) and ACL reconstruction can improve knee function, reduce pain and allow patients with meniscal defect and ACL lesion to resume sport activities.MethodsFifty MAT, arthroscopically performed without bone plugs and combined with one-stage primary or revision ACL reconstruction, with or without high tibial osteotomy (HTO), were included. Patients (aged 38.2  ± 10.6 years, 87% males) were evaluated at a mean follow-up of 5 years with Lysholm, Tegner and VAS scores. Patient satisfaction was also recorded...
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
ConclusionsThe findings of this study showed that anterior knee laxity is restored with revision BPTB autograft ACLR after failed primary HT autograft ACLR, in the same cohort of patients. However, revision ACLR showed a significantly inferior functional knee outcome compared with primary ACLR. It is important for clinicians to inform and set realistic expectations for patients undergoing revision ACLR. Patients must be aware of the fact that having revision ACLR their knee function will not improve as much as with primary ACLR and the final postoperative functional outcome is inferior.Level of evidenceRetrospective cohort study, Level III.
Source: Knee Surgery, Sports Traumatology, Arthroscopy - Category: Orthopaedics Source Type: research
Publication date: Available online 11 June 2018Source: Arthroscopy TechniquesAuthor(s): Avinesh Agarwalla, Richard Puzzitiello, Grant H. Garcia, Brian ForsytheAbstractAnterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone autograft yields good clinical outcomes. Despite appropriate clinical outcomes, the most common complaint after reconstruction with a bone–patellar tendon–bone autograft is anterior knee pain at the donor graft sites. Synthetic bone grafts, such as beta-tricalcium phosphate (β-TCP), have been previously used to fill the bony defect in fractures as wel...
Source: Arthroscopy Techniques - Category: Surgery Source Type: research
ConclusionIt is ascertained that no significant retro-patellar pain or shortening of the patellar tendon occurs following a bone patella tendon bone harvest. The bone patella bone tendon graft is a suitable graft for ligament reconstruction with good functional outcome, and no significant adverse effect of patella baja or anterior knee pain in the Indian patients.Level of EvidenceLevel IV.
Source: Journal of Clinical Orthopaedics and Trauma - Category: Orthopaedics Source Type: research
Publication date: Available online 11 June 2018Source: Arthroscopy TechniquesAuthor(s): Avinesh Agarwalla, Richard Puzzitiello, Grant H. Garcia, Brian ForsytheAbstractAnterior cruciate ligament (ACL) reconstruction with a bone–patellar tendon–bone autograft yields good clinical outcomes. Despite appropriate clinical outcomes, the most common complaint after reconstruction with a bone–patellar tendon–bone autograft is anterior knee pain at the donor graft sites. Synthetic bone grafts, such as beta-tricalcium phosphate (β-TCP), have been previously used to fill the bony defect in fractures as wel...
Source: Arthroscopy Techniques - Category: Surgery Source Type: research
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