All-inside versus full-tibial tunnel techniques of anterior cruciate ligament reconstruction: a systematic review and meta-analysis / 中华骨科杂志

ABSTRACT

Objective:To compare the clinical efficacy of arthroscopic all-inside technique versus full-tibial tunnel technique for anterior cruciate ligament (ACL) reconstruction.Methods:Literature on all-inside versus full-tibial tunnel for ACL reconstruction was retrieved from databases including China National Knowledge Infrastructure (CNKI), Wanfang Data, Full-text Database of Chinese Medical Journals, PubMed, Web of Science, and Cochrane Library from their establishment to February 2023. Meta-analysis was performed on the included studies. Random effects model was used if heterogeneity was large, while fixed effects model was used if heterogeneity was small.Results:A total of 13 studies with 511 cases in the all-inside group and 465 cases in the full-tibial tunnel group were included in the meta-analysis, with a mean follow-up of 6-25.8 months. Meta-analysis showed that the graft diameter [ MD=0.42, 95% CI (0.11, 0.73), P=0.007] and International Knee Documentation Committee (IKDC) subjective score [ MD=1.11, 95% CI (0.36, 1.86), P=0.004] of the all-inside group was larger than full-tibial tunnel group, and the tibial tunnel widening of the all-inside group was less than full-tibial tunnel group [ MD=-1.70, 95% CI (-2.38, -1.01), P<0.001]. There were no significant differences in IKDC objective score [ OR=1.09, 95% CI (0.67, 1.78), P=0.730], Lysholm score [ MD=0.99, 95% CI (-0.08, 2.05), P=0.070], Tegner activity score [ MD=-0.01, 95% CI (-0.48, 0.45), P=0.950], bilateral knee anterior laxity difference [ MD=0.32, 95% CI (-0.22, 0.86), P=0.250], negative rate of pivot shift test [ OR=0.80, 95% CI (0.33, 1.91), P=0.610], graft re-rupture rate [ OR=0.76, 95% CI (0.34, 1.74), P=0.524] and return to sport rate [ OR=1.56, 95% CI (0.85, 2.86), P=0.150]. Conclusion:All-inside ACL reconstruction provides satisfactory efficacy. Compared with full-tibial tunnel technique, it has the advantages of larger graft diameter and less tibial tunnel widening, with no difference in joint function within 2 years postoperatively.