2017 ISAKOS Biennial Congress ePoster #1050

 

All-Inside Graft-Link Technique Versus Full-Tibial Tunnel Technique for ACL Reconstruction: Clinical, Isokinetic and Radiological Results at 1 Year Follow-Up

Andrea Redler, MD, Rome ITALY
Edoardo Monaco, MD, Rome ITALY
Mattia Fabbri, MD, Rome ITALY
Daniele Mazza, MD, Fiumicino ITALY
Angelo De Carli, MD, Rome ITALY
Andrea Ferretti, Prof., Rome, RM ITALY

Sant'andrea Hospital, rome, italy, ITALY

FDA Status Cleared

Summary

the All-Inside technique demonstrated equivalent clinical and knee-stability outcome along with a significant better isokinetic flexion strength at lower angular velocity and less tunnel widening at the tibial side compared to a full tibial tunnel technique with interference fixation.

Abstract

Background

The recently described "All-Inside graft-link technique" for ACL reconstruction provide bone sockets creation and graft fixation using an adjustable loop length device both on femur and tibia. Concerns exist about possible loop lengthening after fixation, leading to graft loosening and surgical failure.

Purpose

To compare the clinical, isokinetic flexion strength and radiological results of the All-Inside technique to those of a full-tibial tunnel technique for ACL reconstruction.

Methods

44 patients were retrospectively enrolled at a mean follow-up of 24±3 months (Group A: 22 patients, All-Inside technique; Group B: 22, full-tibial tunnel technique). At follow-up, all patients underwent clinical (IKDC, KSS, Tegner and Lysholm scores), knee-laxity (KT-2000), isokinetic flexion strength assessment and tunnel widening evaluation with CT scan.

Results

In Group A, a significant improvement was found for Lysholm score (p=0.01), KSS (p=0.01) and IKDC form (p=0.01) The mean side to side was 1.75 ± 1.2 mm.
In Group B, a significant improvement was found for Lysholm score (p=0.005), KSS (p=0.005) and IKDC form (p=0.005). The mean side to side difference was 2.1 ± 1.2 mm.
In group A the mean peak flexion torque was 7.2% and the mean torque at 30° was 3.1%, while in group B the mean peak flexion torque was -7.2% and the mean torque at 30° was -11% at low angular velocity (60°/sec), with better results in group A (p=0.009). Radiological evaluation showed significant less tunnel widening in group A at the middle (p=0.027) and articular (p=0.028) portion of the tibial tunnel.

Conclusion

The All-Inside technique yielded equivalent clinical and knee-stability outcome along with a significant better isokinetic flexion strength at lower angular velocity and less tunnel widening at the tibial side compared to a full tibial tunnel technique with interference fixation. Suspensory fixation with an adjustable loop length device, allowing bone stock preservation and less tunnel widening, seem to be a valid option for the tibial side which historically have been considered the weakest point in ACL reconstruction