TY - JOUR
T1 - Anterior Cruciate Ligament Reconstruction With Hamstring Autograft
T2 - A Matched Cohort Comparison of the All-Inside and Complete Tibial Tunnel Techniques
AU - Desai, Vishal S.
AU - Anderson, Gregory R.
AU - Wu, Isabella T.
AU - Levy, Bruce A.
AU - Dahm, Diane L.
AU - Camp, Christopher L.
AU - Krych, Aaron J.
AU - Stuart, Michael J.
N1 - Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: B.A.L. receives royalties from Arthrex; is a paid consultant for Arthrex and Smith & Nephew; and receives research support from Arthrex, Biomet, Smith & Nephew, and Stryker. D.L.D. receives research support from Arthrex and is a member of the NBA/GE Strategic Advisory Board, and her spouse has stock/stock options in and receives royalties from Tenex Health and Sonex Health. C.L.C. has received educational support from Arthrex and Zimmer Biomet and hospitality payments from Arthrex. A.J.K. receives research support from Aesculap/B. Braun and the Arthritis Foundation; receives royalties from Arthrex; and is a paid consultant for Arthrex, Vericel, DePuy Orthopaedics, and the Musculoskeletal Transplant Foundation. M.J.S. receives royalties from Arthrex, is a paid consultant for Arthrex, receives research support from Stryker, and has received hospitality payments from Gemini Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from the Mayo Clinic (IRB No. 15-000601).
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Surgical reconstruction of the anterior cruciate ligament (ACL) is one of the most common orthopaedic procedures, with an estimated 100,000 to 175,000 procedures performed annually. Recently, the all-inside reconstruction technique has come into favor and is theorized to be superior to the complete tibial tunnel technique. Purpose: To compare clinical and patient-reported outcomes (PROs) for hamstring autograft ACL reconstruction (ACLR) performed with an all-inside versus a complete tibial tunnel technique. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent hamstring autograft ACLR via either an all-inside approach (femoral and tibial sockets) or a complete tibial tunnel approach (femoral socket and full-length, transtibial tunnel) at a single institution between July 2011 and July 2015 were reviewed. Demographic information, preoperative comorbidities, surgical details, physical examination findings, and follow-up outcomes were extracted from the medical record. Physical examination data included pivot-shift, Lachman, and range of motion examinations, whereas PROs included the Tegner activity scale, Lysholm score, and International Knee Documentation Committee (IKDC) score at a minimum of 2 years after surgery. Return to sport and risk factors for failure were analyzed. Results: A total of 82 patients (mean ± SD age, 25.8 ± 10.2 years) who underwent all-inside reconstruction (median PRO follow-up, 30.1 months; range, 24.7-72.9 months) and 54 patients (mean ± SD age, 21.1 ± 7.3 years) who underwent complete tibial tunnel reconstruction (median PRO follow-up, 25.8 months; range, 23.9-74.5 months) met the inclusion criteria. PRO scores at latest follow-up were comparable between the all-inside versus the complete tibial tunnel groups (Lysholm score, 93.8 vs 94.4, P =.621; IKDC score, 93.5 vs 93.3, P =.497; Tegner activity score, 6.4 vs 6.8, P =.048). Complications (including graft failure) were experienced by 20% of patients in the all-inside group compared with 24% in the complete tibial tunnel group (P =.530). Graft failure before the final follow-up was experienced by 10% of patients in the all-inside group compared with 19% in the complete tibial tunnel group (P =.200). Mean return to sport was 12.5 months in the all-inside group versus 9.9 months in the complete tibial tunnel group (P =.028). Conclusion: All-inside and complete tibial tunnel hamstring autograft ACLR resulted in excellent physical examination findings and PROs at minimum 2-year follow-up. Both techniques successfully restored knee stability and patient function.
AB - Background: Surgical reconstruction of the anterior cruciate ligament (ACL) is one of the most common orthopaedic procedures, with an estimated 100,000 to 175,000 procedures performed annually. Recently, the all-inside reconstruction technique has come into favor and is theorized to be superior to the complete tibial tunnel technique. Purpose: To compare clinical and patient-reported outcomes (PROs) for hamstring autograft ACL reconstruction (ACLR) performed with an all-inside versus a complete tibial tunnel technique. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent hamstring autograft ACLR via either an all-inside approach (femoral and tibial sockets) or a complete tibial tunnel approach (femoral socket and full-length, transtibial tunnel) at a single institution between July 2011 and July 2015 were reviewed. Demographic information, preoperative comorbidities, surgical details, physical examination findings, and follow-up outcomes were extracted from the medical record. Physical examination data included pivot-shift, Lachman, and range of motion examinations, whereas PROs included the Tegner activity scale, Lysholm score, and International Knee Documentation Committee (IKDC) score at a minimum of 2 years after surgery. Return to sport and risk factors for failure were analyzed. Results: A total of 82 patients (mean ± SD age, 25.8 ± 10.2 years) who underwent all-inside reconstruction (median PRO follow-up, 30.1 months; range, 24.7-72.9 months) and 54 patients (mean ± SD age, 21.1 ± 7.3 years) who underwent complete tibial tunnel reconstruction (median PRO follow-up, 25.8 months; range, 23.9-74.5 months) met the inclusion criteria. PRO scores at latest follow-up were comparable between the all-inside versus the complete tibial tunnel groups (Lysholm score, 93.8 vs 94.4, P =.621; IKDC score, 93.5 vs 93.3, P =.497; Tegner activity score, 6.4 vs 6.8, P =.048). Complications (including graft failure) were experienced by 20% of patients in the all-inside group compared with 24% in the complete tibial tunnel group (P =.530). Graft failure before the final follow-up was experienced by 10% of patients in the all-inside group compared with 19% in the complete tibial tunnel group (P =.200). Mean return to sport was 12.5 months in the all-inside group versus 9.9 months in the complete tibial tunnel group (P =.028). Conclusion: All-inside and complete tibial tunnel hamstring autograft ACLR resulted in excellent physical examination findings and PROs at minimum 2-year follow-up. Both techniques successfully restored knee stability and patient function.
KW - anterior cruciate ligament reconstruction; ACL; all-inside; complete tibial tunnel
UR - http://www.scopus.com/inward/record.url?scp=85059767339&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85059767339&partnerID=8YFLogxK
U2 - 10.1177/2325967118820297
DO - 10.1177/2325967118820297
M3 - Article
AN - SCOPUS:85059767339
VL - 7
JO - Orthopaedic Journal of Sports Medicine
JF - Orthopaedic Journal of Sports Medicine
SN - 2325-9671
IS - 1
ER -