| Objectives: Anterior cruciate ligament(ACL)injury is one of the most common sports system injuries in clinical practice,and its incidence has been increasing in recent years.Chronic knee instability after injury may lead to secondary meniscus injury and osteoarthritis.Anterior cruciate ligament reconstruction(ACLR)to restore joint stability is currently recognized as an ideal treatment for anterior cruciate ligament injury.However,there are still controversies about graft selection and fixation method.The anteromedial arthroscopic portal(AMP)technique using autologous hamstring tendon is the most common operation method,this technique allows anatomical positioning of the femoral tunnel,the femoral side is fixed with suspension,the tibial side needs an intact tunnel,and the compression screw is fixed.The All-inside technique(AIT)is an emerging technique in recent years,which uses a single bundle of semitendinosus tendon as a graft,and the femoral and tibial sides are suspended and fixed by closed bone tunnel,it has attracted more and more attention because it can retain the gracilis tendon.The aim of this study is to compare the clinical outcomes of the two surgical techniques in terms of functional recovery and joint stability recovery.Methods: A retrospective study was conducted on 54 patients with anterior cruciate ligament injury in our hospital from October 2020 to October 2021.According to the surgical methods,they were divided into the all-inside group and the traditional group,with 27 cases in each group.The all-inside group underwent all-inside technique anterior cruciate ligament reconstruction surgery,and the traditional group underwent anterior cruciate ligament reconstruction surgery through the anteromedial arthroscopic portal technique.The operation time,the difference of anterior tibial translation of bilateral knee joints before and after operation,VAS score,Lysholm score,and IKDC score at different time points after operation were compared between the two groups.Results: Fifty-four patients were followed up for at least 12 months.During the followup,there were no complications such as graft failure and incision infection in the two groups.Results: The mean operation time was(59.5±4.6)min in all-inside group and(57.3±6.2)min in the traditional group,with no statistically significant difference(t=1.519,P=0.135).The VAS scores of all-inside group at 1 day,3 days and 2 weeks after operation were(6.81±0.79),(4±0.92),(1.63±0.56),which of the traditional group were(7.81±0.96),(5.93±1.07),(2.81±0.79).The difference was statistically significant(t=-4.18,P<0.05;t=-7.09,P<0.05;t=-6.36,P<0.05),The VAS score at 6 weeks after operation was(0.89±0.32)in the all-inside group and(1±0.55)in the traditional group,and the difference was not statistically significant(t=-0.90,P=0.372).The Lysholm scores of all-inside group before operation,6 weeks after operation,3 months after operation and 6 months after operation were(61.78±6.65),(76.37±2.51),(89.63±1.67)and(91.93±1.57).The scores of traditional group were(60.19±7.78),(76.78±2.34),(89.22±1.60),(92.19±1.84).The differences were not statistically significant(t=0.809,P=0.422;t=-0.616,P=0.541;t=0.916,P=0.364;t=-0.557,P=0.58),the scores of the same group at 2 weeks,3 months and 6 months after operation were significantly improved compared with those before operation(all-inside group t=10.662,P<0.05;t=21.102,P<0.05;t=22.921,P<0.05),(traditional group t=10.617,P<0.05;t=19.005,P<0.05;t=20.809,P<0.05).The International Knee Documentation Committee(IKDC)scores of the all-inside group were(44.19±6.84),(60.70±4.70),(79.04±5.98),(89.0±2.24)before operation,6 weeks,6 months and 1 year after operation,the scores of traditional group were(43.89±3.95),(58.74±5.14),(77.56±6.61),(88.10±3.02).The difference was not statistically significant(t=0.195,P=0.846;t=1.465,P=0.149;t=0.864,P=0.392;t=1.279,P=0.207).In the same group,6 weeks,6 months and 1 year after operation were significantly higher than those before operation,and the difference was statistically significant(all-inside group t=10.34,P<0.05;t=19.929,P<0.05;t=32.339,P<0.05),(traditional group t=11.909,P<0.05;t=22.735,P<0.05;t=46.185,P <0.05).In the all-inside group,the difference of tibial anterior translation between bilateral knees before operation,6 weeks,3 months and 1 year after operation was(5.27±0.81)mm,(0.61±0.41)mm,(0.64±0.34)mm,(0.90±0.30)mm,The traditional group were(5.17±0.80)mm,(0.59±0.38)mm,(0.64±0.31)mm,(0.83±0.29)mm.There was no significant difference between the two groups(t=0.456,P=0.65;t=0.171,P=0.86;t=0.084,P=0.93;t=0.77,P=0.44).The difference of anterior tibial translation between the two groups at 6 weeks,6 months and 1 year after operation was significantly reduced compared with that before operation,and the difference was statistically significant(all-inside group t=-26.75,P<0.05;t=-26.95,P<0.05;t=-25.87,P<0.05),(traditional group t=-26.75,P<0.05;t=-27.41,P<0.05;t=-26.35,P<0.05).One year after operation,the IKDC objective score of the all-inside group was 16 cases of grade A,10 cases of grade B,1 case of grade C,and 0 case of grade D.One year after operation,the objective IKDC score of the all-inside group(16 cases of grade A,10 cases of grade B,1 case of grade C,0 case of grade D)was like that of the traditional group(14 cases of grade A,12 cases of grade B,1 case of grade C,0 case of grade D).There was no significant difference between the two groups(X=0.315,P=0.854).Conclusion: In the early stage after anterior cruciate ligament reconstruction,the pain score of the all-inside group was lower than that of the traditional group,and the results of the joint function score and stability measurement were similar between the two groups,and satisfactory results were achieved.However,all inside technique has the characteristics of preserving the gracilis tendon,reducing bone destruction and early pain improvement,which is conducive for patients to achieve early functional exercise. |
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