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Propensity Score-Matched Comparison of Six-Strand All-Inside and Conventional Four-Strand Hamstring Autografts for
Young Jin Seo1, Si Young Song1, Dongju Kim1
1Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7, Keunjaebong-gil, Hwaseong-si 18450, Republic of Korea.
Journal of Clinical Medicine
|September 13, 2025
Summary
The all-inside ACL reconstruction technique allows for thicker hamstring grafts, leading to improved knee stability and functional outcomes compared to traditional full tibial tunnel methods. This minimally invasive approach shows promise for better anterior laxity control post-surgery.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- All-inside anterior cruciate ligament (ACL) reconstruction offers a minimally invasive alternative to conventional techniques.
- Potential benefits include optimized graft configuration and reduced surgical trauma.
- This study compares clinical outcomes of all-inside versus full tibial tunnel ACL reconstruction.
Purpose of the Study:
- To compare graft diameter, postoperative stability, and functional recovery between all-inside and full tibial tunnel ACL reconstruction.
- To evaluate the hypothesis that the all-inside technique yields superior outcomes, particularly reduced anterior laxity.
Main Methods:
- Retrospective comparative study of 103 ACL reconstruction patients (January 2020 - February 2024).
- Comparison between four-strand hamstring autograft with full tibial tunnel (FT-4) and six-strand hamstring autograft with all-inside technique (AI-6).
- 1:1 propensity score matching (PSM) based on key patient and surgical variables; analysis of graft diameter, knee stability, and functional scores.
Main Results:
- PSM created two comparable groups (n=29 each).
- AI-6 group had significantly larger graft diameter (9.5 mm vs. 7.8 mm) and reduced anterior laxity (1.6 mm vs. 2.5 mm) (p < 0.005).
- AI-6 showed superior Lysholm (82.2 vs. 75.6) and WOMAC (8.0 vs. 12.9) scores (p < 0.023); graft diameter negatively correlated with anterior laxity (p=0.048).
Conclusions:
- The all-inside technique with a six-strand hamstring graft yields thicker grafts and significantly less postoperative anterior knee laxity compared to the full tibial tunnel technique.
- The AI-6 technique demonstrated favorable outcomes in anterior laxity and functional scores (Lysholm, WOMAC).
- This approach may be clinically valuable, especially for patients with smaller graft diameter potential, by facilitating adequate graft thickness.
