2015 ISAKOS Biennial Congress ePoster #1210

Comparison of Early Patient Based Quality of Life Outcomes From the All-Inside and Antero-Medial Portal ACL Reconstruction Techniques

Neil Jain, BM, MRCS(Ed), FRCS(Tr&Orth), Manchester UNITED KINGDOM
Tym Frank, MD, Vancouver CANADA
James Longstaffe, MD, Vancouver CANADA
Michael Gilbart, MD, Vancouver, BC CANADA
Patrick Chin, MD, MBA, FRCSC, Vancouver, BC CANADA
William Regan, MD, Vancouver, British Columbia CANADA
Jordan Michael Leith, MD, FRCSC, Vancouver, BC CANADA

University of British Columbia, Vancouver, British Columbia, CANADA

FDA Status Cleared

Summary: The subjective early quality of life outcomes from ACL reconstruction appear to be preferential to use of an anteromedial portal technique rather than the all-inside technique.




Many techniques are utilised for Anterior Cruciate Ligament (ACL) reconstruction (ACL-R). The All-Inside Graftlink technique is suggested to have many benefits including being less invasive using a single tendon graft and using bone sockets rather than tunnels, having the potential to dock the graft into sockets thereby preventing the infiltration of synovial fluid and the use of suspensory fixation to permit graft tensioning on both the femoral and tibial sides. The absence of interference screws removed the complication of cyst formation. We compared the early results from our series of ACL-R following the introduction of this technique with a series of ACL-R using an anatomical reconstruction using the antero-medial portal.


Three hundred and sixty-four ACL-R were performed over a 20-month period comprising 160 using the All-Inside technique and 204 using an antero-medial portal. We excluded any patients undergoing their surgery as part of a multi-ligament reconstruction, those with allograft and those with other pathology within the knee. This left 70 patients that had an isolated primary ACL reconstruction using the all-inside technique and 113 using the antero-medial portal technique. The mean age of the patients was 30 years for the all-inside group and 32 years for the antero-medial group. The ratio of male to female was 1.6:1 for the all-inside group and 1.5:1 for the antero-medial group. All patients were assessed pre-operatively using the Mohtadi 34-question quality of life scoring system that addresses subjective instability, ability to work, and ability to play sports, apprehension, pain, general function and lifestyle modifications. They were then assessed 1-year post op to compare the responses and assess subjective surgical outcome.


The mean 12-month follow up for the patients with the all-inside technique resulted in an overall Mohtadi score of 2158, demonstrating an increase of 1091 from the pre-op baseline score of 1067. The antero-medial technique group had a 12-month overall score of 2088, producing an increase of 1137 from their baseline of 951. Within the all-inside group 60 patients (86%) described an overall increase from their baseline score at 1 year and 10 patients (14%) described a decrease from their baseline at 1 year, compared to 103 (91%) and 10 (9%) of patients respectively within the antero-medial group. When reviewing the individual domains within the questionnaire, the antero-medial group had better results for subjective less frequency of instability, less pain with instability, less difficulty playing pivoting sports, less fear in contact sports, less limitation in sport, a better general safety, better return to work and less frequency in awareness of their knee. The all-inside technique provided better results with a lower level of cautiousness in playing sport and a greater expectation playing sport. There was no difference in early post-op pain between the groups.


The subjective early quality of life outcomes from ACL reconstruction appear to be preferential to use of an antero-medial portal technique rather than the all-inside technique. Further studies are required to review other outcome measures such as re-rupture rate and objective stability.