Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel

The purpose of this investigation was to compare the clinical effectiveness of full-tunnel anterior cruciate ligament (ACL) reconstructive surgery with all-inside ACL reconstruction.

After statistical power analysis was performed and institutional review board approval and patient informed consent were obtained, 150 patients having ACL reconstruction were prospectively randomized to an all-inside or full-tibial tunnel technique. Outcome (International Knee Documentation Committee [IKDC] Knee Examination Form, IKDC Subjective Knee Evaluation Form, Knee Society Score [KSS], Short Form 12 [SF-12] score, femoral or tibial tunnel or socket widening, narcotic consumption, and visual analog scale [VAS] pain score compared with baseline) was measured and recorded preoperatively and at various postoperative time points with a minimum follow-up of 2 years.

There were no differences between groups with regard to IKDC Knee Examination Form, IKDC Subjective Knee Evaluation Form, KSS score, SF-12 score, or femoral socket or tibial tunnel or socket widening, or narcotic consumption. The VAS pain score compared with baseline was significantly lower for the all-inside technique on day 1, on day 7, at 1.5 weeks, and at 24 months.

The null hypothesis (no difference between all-inside ACL reconstruction and ACL reconstruction with a full tibial tunnel) is supported for IKDC scores, KSS score, SF-12 score, narcotic consumption, and tibial and femoral widening, whereas all-inside ACL reconstruction results in a lower VAS pain score compared with baseline.

Level I, randomized controlled clinical trial with greater than 80% patient follow-up 2 years postoperatively.