Comparative Study Of Clinical Efficacy Of All-inside And Traditional Anatomical Single-bundle Reconstruction Technique Of Anterior Cruciate Ligament

Part Ⅰ.Randomized controlled trial of anterior cruciate ligament all-inside and traditional anatomic single-bundle reconstruction with function and stability,tunnel widening,and graft maturityObjective:In recent years,as a more anatomical,less invasive technique enabling faster recovery,all-inside technology reconstruction of anterior cruciate ligament has been widely supported.In this part,to compare the clinical efficacy of single bundle all-inside and traditional anatomic reconstruction of the anterior cruciate ligament in a prospective randomized controlled trial.Differences in functional improvement,restoration of stability,pain perception,bone tunnel widening,and graft maturity were assessed between the two techniques.Methods:From September 2018 to July 2019,Fifty-four patients were randomly assigned to an all-inside reconstruction group(n=27)or traditional reconstruction group(n=27).The Tegner,International Knee Documentation Committee(IKDC),Lysholm,and VAS score were recorded at postoperative 3,6,and 12 month to assess functional recovery and pain.MRI was conducted to measure the signal/noise quotient(SNQ)of the intra-articular graft to assess the maturity.And the widening of the bone tunnel was measured by CT.Knee laxity was assessed using GNRB arthrometer at the postoperative 12 month.Results:The tibial tunnel widening at postoperative 3,6,and 12 month in all-inside group was significantly less than that in traditional group(P<0.05).There was no statistical difference in femoral tunnel widening between the 2 groups(P>0.05).The graft SNQ of the all-inside group was significantly higher than that of the traditional group at postoperative 6 month(p<0.05).There was no statistical difference in graft SNQ between the two groups at postoperative 3 and 12 month(p>0.05).Both groups exhibited the highest SNQ in the middle region of the graft,followed by the proximal region,and the distal region.Functional scores improved significantly for both groups and had no statistical difference(p>0.05).The VAS score was lower in the all-inside group(p<0.05).The knee laxity was higher in the all-inside group(p<0).05)at postoperative 12 month,There was no correlation between the functional scores and graft maturity in both groups(p>0.05).Conclusion:All-inside and traditional anatomical single-bundle reconstruction show good functional outcomes,but the all-inside reconstruction technique can slow down the widening of the tibial tunnel and reduce postoperative pain.however,knee laxity was relatively higher in the all-inside technique than in the traditional technique,Both techniques exhibited poor maturity in the middle graft region and the best in the distal region.Graft maturity with all-inside technique is inferior to that with traditional technique in the early postoperative stages.Both techniques exhibited there is no correlation between knee function and graft maturity.Part Ⅱ.Meta-analysis of all-inside anatomical single bundle reconstruction of anterior cruciate ligament compared to traditional technology efficacyObjective:In recent years,many clinical studies have compared the efficacy between all-inside cortical suspension fixation and traditional full tibial tunnel interference screw fixation in single-bundle anterior cruciate ligament reconstruction,but the conclusions are controversial.In this part,evidence-based medicine was used to evaluate the efficacy difference of these two fixed technologies in single-bundle anterior cruciate ligament reconstruction.Methods:Search PubMed,Embase and the Cochrane Library databases,and include clinical controlled studies that meet the standards.The quality evaluation adopts the modified Jadad score.RevMan 5.3 software was used to conduct meta-analysis.Subgroup analysis was performed if there were two or more randomized controlled trial(RCTs)or retrospective cohort studies with the same outcome.Results:Nine articles(5 RCTs,4 retrospective cohort studies)were included,and the follow-up was 24 months.Included 645 patients,322 patients in all-inside group(RCT accounted for 51.9%),and 323 patients in the traditional group(RCT accounted for 51.4%).The meta-analysis results show that there is no statistical difference between all-inside group and traditional group in International knee documentation committee(IKDC)score,American knee society knee score(KSS),Knee injury and osteoarthritis outcome score(KOOS),Tegner,Lysholm,KT-1000 stability,graft failure rate,graft diameter and tibial tunnel widening(p>0.05).However,the femoral tunnel widening in the all-inside group was more obvious at 2 years after surgery(p<0.05).The visual analogue score(VAS)of the all-inside group was significantly lower than that of the traditional group at 6 months after surgery(p<0.001).Conclusion:There were no significant differences between all-inside cortical suspension fixation and traditional full tibial tunnel interference screw fixation in terms of functional improvement,stability recovery,tunnel widening,and graft failure rate,but patients after all-inside cortical suspension fixation had less pain.