Clinical and Radiological Outcomes of All-inside Versus Complete Tibial Tunnel Techniques in Anterior Cruciate...

Anterior cruciate ligament (ACL) reconstruction aims to restore knee stability and function while minimizing tunnel-related complications. The all-inside technique was developed to preserve bone stock, reduce post-operative pain, and improved function. This study, therefore, aimed to compare clinical and radiological outcomes between the all-inside and full tibial tunnel ACL reconstruction techniques.

The study prospectively enrolled 60 patients and divided in two groups, 30 patients in each, an all-inside and full tibial tunnel group. At final follow-up, subjective functional scores were used to assess the functional outcome, and magnetic resonance imaging (MRI) was used to assess socket/tunnel widening and graft characteristics. Subjective functional scores included the Lysholm knee score, the International Knee Documentation Committee score, and the knee society score for pain and function. MRI was used to measure the value of bone socket/tunnel widening, graft fiber integrity, graft laxity, and posterior cruciate ligament (PCL) buckling.

At the final follow-up of 18-24 months, no significant differences were found with respect to femoral socket widening and subjective function scores. However, a significant increase in tibial tunnel diameter was found in the full tibial tunnel group compared to the all-inside group (P < 0.005). Knee stability and MRI parameters, including graft continuity, graft laxity, and PCL buckling, were comparable between groups.

Both surgical techniques result in satisfactory clinical and radiological outcomes following ACL reconstruction. However, the all-inside technique offers a radiological advantage by significantly reducing tibial tunnel enlargement, likely due to closed socket creation and suspensory fixation, making it a biomechanically favorable option without compromising functional results.