2015 ISAKOS Biennial Congress ePoster #1383

Early Quality of Life Patient Based Outcomes from the All-Inside Graftlink Anterior Cruciate Ligament Reconstruction Technique

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
Jordan Michael Leith, MD, FRCSC, Vancouver, BC CANADA

University of British Columbia, Vancouver, British Columbia, CANADA

FDA Status Cleared

Summary: The subjective outcomes from the All-Inside Graftlink technique for ACL reconstruction appear to be promising with an average increase in quality of life score by over 100% of a baseline pre-operative score.




Many different techniques have been described and are utilised for Anerior Cruciate Ligament (ACL) reconstruction. The All-Inside Graftlink technique is suggested to have many benefits. The advocates of this technique propose it to be less invasive using a single tendon graft and using bone sockets rather than tunnels. Advantages to enhance healing are suggested to be the potential to dock the well fitting graft into the 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. In addition suspensory fixation should avoid the possible formation of cysts seen with interference screws on occasion and prevent tibial pain from the site of tibial screw insertion. Some suggest that this technique permits the most reproducible anatomical positioning of the graft as the socket aperture may be positioned regardless of the degree of knee flexion. We present the early results from our series of ACL reconstruction following the introduction of this technique at a tertiary referral centre.


One hundred and sixty ACL reconstructions were performed using the All-Inside technique over a 20-month period. We excluded any patients that received their surgery as part of a multi-ligament reconstruction, those with allograft and those with other pathology observed within the knee. This left 70 patients that had an isolated primary ACL reconstruction using this technique. The mean age of the patients was 30 years. The ratio of male to female was 1.6:1. All patients were assessed pre-operatively using a 34 question quality of life scoring (Mohtadi QoL) that addresses subjective instability, ability to work, ability to play sports apprehension, pain, general function and lifestyle modifications. They were then assessed at 1-year post op to compare the responses and assess whether the surgery had been of benefit.


The mean 12-month follow up for the patients resulted in an overall Mohtadi score of 2158, which was an increase of 1091 from the pre-op baseline score of 1067. 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. The highest percentage increase within the questionnaire was with confidence in returning to sport. However these patients also scored noticeably to be high on cautiousness with sport and fear of re-injury.


The subjective outcomes from the All-Inside technique for ACL reconstruction appear to be promising with an average increase in quality of life score by over 100% of a baseline pre-operative score. Eighty-six percent of patients describe an improvement following this surgery however further study is required to determine the benefit compared with other more established techniques.