Endoscopic versus rear-entry ACL reconstruction: a systematic review

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Biomechanical Engineering

Background:

• Anterior cruciate ligament (ACL) reconstruction is a common orthopedic procedure.
• Two primary surgical techniques exist: all-endoscopic (all-inside) and rear-entry (outside-in).
• Understanding the comparative efficacy of these techniques is crucial for surgical decision-making.

Purpose of the Study:

• To systematically review prospective, randomized clinical trials comparing all-endoscopic and rear-entry ACL reconstruction.
• To evaluate differences in operative time, knee stability, and return to activity.
• To assess functional outcomes, pain, and patient-reported scores.

Main Methods:

• Systematic review of four prospective, randomized clinical trials.
• Comparison of all-endoscopic versus rear-entry ACL reconstruction techniques.
• Analysis of data including operative time, KT-2000 arthrometer measurements, return to activity rates, and various functional outcome scores.

Main Results:

• Operative time was shorter in the all-endoscopic group in two studies.
• A higher percentage of patients in the rear-entry group showed less than 3 mm difference on the KT-2000 arthrometer.
• No significant differences were observed in pain medication, rehabilitation progression, range of motion, strength, patellofemoral pain, hop tests, or outcome scores (Lysholm, Tegner, IKDC).

Conclusions:

• Both all-endoscopic and rear-entry ACL reconstruction techniques demonstrate similar overall patient outcomes.
• While minor differences in operative time and knee stability exist, functional recovery and patient satisfaction appear comparable.
• The choice between techniques may depend on surgeon preference and specific patient factors.