2015 ISAKOS Biennial Congress ePoster #1374

Clinical Outcomes Using TransLateral All-Inside ACL Reconstruction

Sam K. Yasen, MBBS, MScEng, BSc, MRCS, FRCS(Tr&Orth), PGCE, Basingstoke, Hampshire UNITED KINGDOM
Victoria Yates
Alistair Ian Eyre-Brook, BM, BMedSci, Taunton UNITED KINGDOM
Breck R. Lord, MA, MBBS, PhD, FRCS, Sydney, New South Wales AUSTRALIA
Bhushan Sabnis, FRCS, Basingstoke UNITED KINGDOM
David W. Elson, MBChB, MRCS, FRCS (T&O), Newcastle upon Tyne, Tyne & Wear UNITED KINGDOM
Felicity Wandless, Physiotherapy, Basingstoke UNITED KINGDOM
Michael J. Risebury, MBBS(Hons), MA(Hons), FRCS(Tr&Orth), Basingstoke, Hampshire UNITED KINGDOM
Adrian J. Wilson, MBBS BSc FRCS, London UNITED KINGDOM
Basingstoke and North Hampshire Hospital, Basingstoke, Hampshire, UNITED KINGDOM

FDA Status Cleared

Summary: We present the outcomes of a large cohort of patients undergoing ACL reconstruction using a modified all-inside procedure, demonstrating excellent short term subjective and objective outcomes.

Abstract:

Introduction

Current practices in anterior cruciate ligament (ACL) reconstruction fail to restore normal knee kinematics. In vitro studies demonstrate biomechanical advantages of anatomic positioning in single bundle reconstructions over traditional techniques. We present the clinical outcomes in a series of 235 patients, mean age 32 years (range 10-74) who underwent anatomic all-inside ACL reconstruction, using the TransLateral surgical technique at a mean follow up of 24.3 months.

Methods

The semitendinosus alone is harvested, quadrupled and attached in series to two adjustable suspensory cortical fixation devices. Anatomic placement on the femur is achieved using the validated direct measurement technique. Femoral and tibial sockets are created with a retrograde drill. Patients were evaluated preoperatively and at 6, 12 and 24 months postoperatively using the KOOS, Tegner and Lysholm scoring indices. Knee laxity was assessed using KT-1000 along with goniometric measurement of range or motion.

Results

Overall complication rate 9.4 % (22 cases). There were 10 graft failures (4.3%) - 6 due to significant postoperative trauma. Other complications include 5 superficial wound infections treated with oral antibiotics,3haemarthroses, 3 knees with postoperative stiffness requiring manipulation and 1 patient who developed chronic regional pain syndrome. Mean increase at 2 years in KOOS, 29.4 points; Tegner, 1.9 levels; and Lysholm, 32.2 points. Mean range of movement at 24 months, 1o hyperextension to 138o flexion. KT-1000 improved to 2.6mm side-side difference (p<0.001).

Conclusion

The TransLateral approach allows excellent visualisation of the lateral femoral condyle, and facilitates anatomic ACL graft placement. The described technique is safe, reproducible and bone-conserving. Early clinical results are comparable to traditional ACL reconstruction. We hypothesise that the biomechanical advantages conferred by anatomic positioning may reduce the long-term incidence of osteoarthritis.