Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shift
AimThis study aimed to evaluate the early efficacy of combined all-inside anterior cruciate ligament (ACL) reconstruction and anterolateral tendon fixation in addressing knee instability associated with ACL rupture and high-grade anterior tibial translation (≥10 mm).MethodsIn this prospective cohort...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1614925/full |
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| author | Haoran Gu Aifang Niu Jingrui Ji Miao He Ying Yang Junxia Lu Jianghong Lv Yongdong Yi Hui Zhou Wuping Zhou |
| author_facet | Haoran Gu Aifang Niu Jingrui Ji Miao He Ying Yang Junxia Lu Jianghong Lv Yongdong Yi Hui Zhou Wuping Zhou |
| author_sort | Haoran Gu |
| collection | DOAJ |
| description | AimThis study aimed to evaluate the early efficacy of combined all-inside anterior cruciate ligament (ACL) reconstruction and anterolateral tendon fixation in addressing knee instability associated with ACL rupture and high-grade anterior tibial translation (≥10 mm).MethodsIn this prospective cohort study, 21 patients (16 men, 5 women; mean age: 27.4 ± 5.8 years) with ACL rupture and grade III anterior tibial displacement were selected from 90 consecutive cases treated between January 2019 and January 2020. All procedures were performed by a single surgeon using autologous semitendinosus tendon grafts (diameter: 8–9 mm). The all-inside ACL reconstruction was augmented with anterolateral tendon fixation utilizing the posterior fibers of the iliotibial band. Postoperative evaluations were conducted at immediate, 1-, 3-, 6-, and 12-month intervals and included: objective stability testing (Lachman and pivot-shift tests), functional outcome assessments (IKDC, Lysholm, and KOOS scores), and radiographic measurement of anterior tibial displacement.ResultsAll patients completed at least 12 months of follow-up, with no reported cases of recurrent instability. Immediate postoperative assessments revealed negative Lachman and pivot-shift tests in 100% of patients, indicating restored knee stability. At the 12-month follow-up, 90.5% (19/21) of patients maintained full stability, while the remaining two exhibited only grade I laxity, representing a significant improvement from preoperative grade III instability (P < 0.001). Functional outcomes also improved markedly, with mean IKDC scores increasing from 48.6 ± 10.3 preoperatively to 86.7 ± 3.6 at 12 months (P < 0.001), and Lysholm scores rising from 52.6 ± 12.4 to 89.6 ± 2.9 (P < 0.001). At final follow-up, 52.4% (11/21) of patients achieved “excellent” and 38.1% (8/21) “good” ratings on the Lysholm scale (P < 0.001 vs. baseline). Additionally, KOOS subscale analysis demonstrated significant pain reduction, with scores improving from 45.2 ± 9.1 preoperatively to 88.3 ± 4.7 postoperatively (P < 0.001).ConclusionCombined all-inside ACL reconstruction and anterolateral tendon fixation could effectively restore anterior and rotational stability in knees with ACL rupture and high-grade tibial displacement. Early outcomes demonstrate promising functional recovery and objective stability at short-term follow-up, suggesting that this technique may offer biomechanical benefits for managing severe instability patterns. However, long-term studies are needed to confirm the durability of these results. |
| format | Article |
| id | doaj-art-96d3cea114bc494eaa0271199d6034c6 |
| institution | DOAJ |
| issn | 2296-875X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj-art-96d3cea114bc494eaa0271199d6034c62025-08-20T02:40:29ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2025-07-011210.3389/fsurg.2025.16149251614925Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shiftHaoran Gu0Aifang Niu1Jingrui Ji2Miao He3Ying Yang4Junxia Lu5Jianghong Lv6Yongdong Yi7Hui Zhou8Wuping Zhou9Traumatic Orthopedics, Army 947 Hospital, Kashgar, Xinjiang, ChinaHealth Service Training Center, Army 947 Hospital, Kashgar, Xinjiang, ChinaNursing Department, Air Force Medical University, Xi’an, Shanxi, ChinaTraumatic Orthopedics, Army 947 Hospital, Kashgar, Xinjiang, ChinaMedical Care Center, Army 947 Hospital, Kashgar, Xinjiang, ChinaDepartment of Psychology and Neurology, Army 947 Hospital, Kashgar, Xinjiang, ChinaTraumatic Orthopedics, Army 947 Hospital, Kashgar, Xinjiang, ChinaTraumatic Orthopedics, Army 947 Hospital, Kashgar, Xinjiang, ChinaTraumatic Orthopedics, Army 947 Hospital, Kashgar, Xinjiang, ChinaTraumatic Orthopedics, Army 947 Hospital, Kashgar, Xinjiang, ChinaAimThis study aimed to evaluate the early efficacy of combined all-inside anterior cruciate ligament (ACL) reconstruction and anterolateral tendon fixation in addressing knee instability associated with ACL rupture and high-grade anterior tibial translation (≥10 mm).MethodsIn this prospective cohort study, 21 patients (16 men, 5 women; mean age: 27.4 ± 5.8 years) with ACL rupture and grade III anterior tibial displacement were selected from 90 consecutive cases treated between January 2019 and January 2020. All procedures were performed by a single surgeon using autologous semitendinosus tendon grafts (diameter: 8–9 mm). The all-inside ACL reconstruction was augmented with anterolateral tendon fixation utilizing the posterior fibers of the iliotibial band. Postoperative evaluations were conducted at immediate, 1-, 3-, 6-, and 12-month intervals and included: objective stability testing (Lachman and pivot-shift tests), functional outcome assessments (IKDC, Lysholm, and KOOS scores), and radiographic measurement of anterior tibial displacement.ResultsAll patients completed at least 12 months of follow-up, with no reported cases of recurrent instability. Immediate postoperative assessments revealed negative Lachman and pivot-shift tests in 100% of patients, indicating restored knee stability. At the 12-month follow-up, 90.5% (19/21) of patients maintained full stability, while the remaining two exhibited only grade I laxity, representing a significant improvement from preoperative grade III instability (P < 0.001). Functional outcomes also improved markedly, with mean IKDC scores increasing from 48.6 ± 10.3 preoperatively to 86.7 ± 3.6 at 12 months (P < 0.001), and Lysholm scores rising from 52.6 ± 12.4 to 89.6 ± 2.9 (P < 0.001). At final follow-up, 52.4% (11/21) of patients achieved “excellent” and 38.1% (8/21) “good” ratings on the Lysholm scale (P < 0.001 vs. baseline). Additionally, KOOS subscale analysis demonstrated significant pain reduction, with scores improving from 45.2 ± 9.1 preoperatively to 88.3 ± 4.7 postoperatively (P < 0.001).ConclusionCombined all-inside ACL reconstruction and anterolateral tendon fixation could effectively restore anterior and rotational stability in knees with ACL rupture and high-grade tibial displacement. Early outcomes demonstrate promising functional recovery and objective stability at short-term follow-up, suggesting that this technique may offer biomechanical benefits for managing severe instability patterns. However, long-term studies are needed to confirm the durability of these results.https://www.frontiersin.org/articles/10.3389/fsurg.2025.1614925/fullanterior cruciate ligament reconstructionall-inside techniqueanterolateral augmentationrotational stabilityhigh-grade anterior tibial translation |
| spellingShingle | Haoran Gu Aifang Niu Jingrui Ji Miao He Ying Yang Junxia Lu Jianghong Lv Yongdong Yi Hui Zhou Wuping Zhou Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shift Frontiers in Surgery anterior cruciate ligament reconstruction all-inside technique anterolateral augmentation rotational stability high-grade anterior tibial translation |
| title | Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shift |
| title_full | Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shift |
| title_fullStr | Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shift |
| title_full_unstemmed | Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shift |
| title_short | Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shift |
| title_sort | arthroscopic all inside acl reconstruction with anterolateral tendon fixation a prospective cohort study on restoring rotational stability in high grade tibial shift |
| topic | anterior cruciate ligament reconstruction all-inside technique anterolateral augmentation rotational stability high-grade anterior tibial translation |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1614925/full |
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