Issue: October 2020
Perspective from Bryson P. Lesniak, MD
Source: Galan H, et al. J Exp Orthop. 2020;doi:10.1186/s40634-020-00226-w.
Disclosures: Slullitel reports no relevant financial disclosures.
October 19, 2020
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All-inside ACL reconstruction improved functional outcomes

Issue: October 2020
Perspective from Bryson P. Lesniak, MD
Source: Galan H, et al. J Exp Orthop. 2020;doi:10.1186/s40634-020-00226-w.
Disclosures: Slullitel reports no relevant financial disclosures.
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Study results showed an all-inside full-thickness quadriceps tendon technique for ACL reconstruction yielded good to excellent functional results with low complication rates and comorbidities in young, high-demand athletes.

Daniel Slullitel, MD, and colleagues collected functional scales of Lysholm scores, IKDC scores, Tegner scores and objective results of side-to-side differences among 291 patients who underwent isolated primary ACL reconstruction using autologous full-thickness quadriceps tendon graft with bone block with an all-inside technique. Researchers analyzed complications and comorbidities.

Results showed Lysholm scores improved from 64 points preoperatively to 91 points at 5 years postoperatively. Although 22% of patents reported an ability to perform moderate activity and 78% of patients reported a sedentary life prior to surgery, researchers found 82% of patients reported being able to perform high-level physical activity and 10% of patients reported being able to perform mild activities at 5 years postoperatively. Researchers noted 59.79% and 3.4% of patients reported excellent and good IKDC scores, respectively. According to results of the arthrometric analysis, 89% of knees had a side-to-side difference of less than 3 mm. Results showed a median pre-injury Tegner score of 9 and a final median Tegner activity level of 8 at 5 years, with 73.3% of patients reporting return to their competitive pre-injury activity level.

At final follow-up, researchers found anterior knee pain in 5.15% of patients. Although two patients had a patellar fracture at the time of harvesting the graft that required fixation and led to a delay in immediate postoperative motion, researchers noted neither of these patients had decreased range of motion at 5-year follow-up.

Results showed 10.7% of patients experienced ACL re-rupture. Researchers reported no visualization difficulties or significant hematomas.

“Although this ‘all inside’ [full-thickness quadriceps tendon] FQT reports knee stability, complication rates and comorbidities similar to other types of reconstruction techniques, however our study is performed in a younger, more active sports involved population with a longer follow-up,” the authors wrote. “Nevertheless, we think that future prospective types comparing different quad reconstruction types are needed.”