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All-inside versus traditional techniques of anterior cruciate ligament reconstruction: meta-analysis of therapeutic efficacy and radiological outcomes
Wang Feng, Cao Chunfeng, He Chao, Zhang Tao, Zhou Zixian, Zhu Fengchen
2025, 29 (35):
7629-7638.
doi: 10.12307/2025.938
OBJECTIVE: To compare the clinical efficacy and radiological results of arthroscopic all-inside technique and traditional technique in anterior cruciate ligament reconstruction.
METHODS: Databases such as CNKI, WanFang, VIP, PubMed, Web of Science, Embase, and Cochrane Library were searched for literature on all-inside technique and traditional technique in anterior cruciate ligament reconstruction. The search time was from the establishment of each database to September 2024. Meta-analysis was conducted on the included literature.
RESULTS: (1) A total of 17 articles were included in the meta-analysis, with 631 patients in the all-inside technique reconstruction group and 626 patients in the traditional technique reconstruction group. The earliest time for the last follow-up was half a year after surgery, and the latest was 5 years after surgery. Most follow-up period was 2 years. (2) Meta-analysis results showed that compared with traditional anterior cruciate ligament reconstruction, the all-inside technique had a thicker graft during anterior cruciate ligament reconstruction [mean difference (MD)=0.20, 95% confidence interval (CI) (0.09, 0.31), P=0.000 5], smaller postoperative maximum diameter [standardized mean difference (SMD)=-3.64, 95% CI (-6.00, -1.28), P=0.002] and volume [SMD=-3.69, 95% CI (-5.37, -2.00), P < 0.000 1] of the tibial tunnel, and higher International Knee Documentation Committee subjective scores [MD=2.41, 95% CI (0.49, 4.32), P=0.01] and Lysholm scores [MD=1.11, 95% CI (0.42, 1.8), P=0.002] 2 years after surgery. However, the operation time was relatively longer [MD=10.06, 95% CI (4.71, 15.4), P=0.000 2], and the knee stability was poorer after 2 years [SMD=0.3, 95% CI (0.04, 0.55), P=0.02]. No significant differences were found between the two groups in the following aspects: the subjective scores of the International Knee Documentation Committee at 6 months and 1 year postoperatively [MD= -0.05, 95% CI (-1.96, 1.83), P=0.96; MD=0.51, 95% CI (-1.17, 2.19), P=0.55]; the difference in anterior laxity of bilateral knees at 1 year postoperatively [SMD=-0.02, 95% CI (-0.3, 0.27), P=0.9]; the Lysholm score at 6 months postoperatively [MD=0.87, 95% CI (-0.15, 1.89), P=0.09]; the objective score of the International Knee Documentation Committee at the last follow-up [RR=0.95, 95% CI (0.86, 1.06), P=0.37]; the American Knee Society Score at the last follow-up [MD=0.33, 95% CI (-0.55, 1.21), P=0.47]; the Tegner score at the last follow-up [MD=0.05, 95% CI (-0.11, 0.22), P=0.53]; the negative rate of the pivot shift test at the last follow-up [RR=0.92, 95% CI (0.83, 1.01), P=0.09]; the postoperative revision rate at the last follow-up [RR=2.2, 95% CI (0.98, 4.92), P=0.05]; and the result of the single-leg hop test at the last follow-up [MD=-0.06, 95% CI (-4.99, 4.86), P=0.98].
CONCLUSION: There were no significant differences in most functional outcome scores and the position of the tibial tunnel between the all-inside technique and the traditional technique after anterior cruciate ligament reconstruction. The all-inside technique was more favorable in terms of subjective International Knee Documentation Committee scores and Lysholm scores at 2 years postoperatively. Meanwhile, the knee joint was more stable 2 years after anterior cruciate ligament reconstruction using the traditional technique. In addition, it was found that the graft was thicker during the all-inside technique, while the diameter and volume of the tibial tunnel were smaller postoperatively, with more bone tissue preserved. Nevertheless, the operation time of the all-inside technique was longer.
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