Summary

Anterior cruciate ligament reconstruction with an all-inside technique and a short, quadruped semitendinosus tendon autograft yields satisfactory results at 2 years compared to the conventional hamstring technique with a semitendinosus/gracilis tendon autograft.

Abstract

Background

Our aim was 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 versus 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.

Methods

A total of 86 patients were enrolled and prospectively followed. Group A comprised 44 patients treated with the all-inside technique and Group B included 42 patients treated with the conventional ACL technique (52 males, 34 females; mean age, 28.7 ± 11.2 years). Patients completed the Tegner-Lysholm 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. A comparison of outcome measures between the two groups at 24 months was performed.

Results

At 2 years, the Tegner-Lysholm, IKDC, KOOS and KSS scores between the two groups were similar. Anterior tibial translation between the operative and non-operative knee was also similar among the two groups. Patients of Group A had significantly better flexor peak torque, time-to-peak and total work at 180 degrees/sec, and significantly better isometric flexor/extensor ratio at 90 degrees/sec.

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.