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This study aims to compare the functional outcomes of patients with ACL rupture following ACL reconstruction surgery using hamstring grafts, between the all-inside technique and the complete tibial tunnel technique. The hamstring graft, which serves as the tissue substitute for the damaged ACL, is harvested from the posterior thigh of the patient and used to replace the torn ligament during reconstruction
This Study was conducted usingdouble blind randomized controlled trial (RCT), patients who agree to participate in the study will be randomized to undergo ACL reconstruction using either the All-inside technique or the complete tibial tunnel technique. Clinical outcomes, including tibial translation, pain severity, IKDC score, and Tegner score, will be evaluated through anamnesis and physical examination at the outpatient orthopedic clinic at 3, 6, 9, and 12 months postoperatively.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| All-Inside Technique | Active Comparator | Patients With ACL Ruptures will undergo ACL reconstruction surgery with All-inside techniques |
|
| Complete Tibial Tunnel | Active Comparator | Patients With ACL Ruptures will undergo ACL reconstruction surgery with complete tibial tunnel techniques |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| All-Inside Techniques | Procedure | All-inside ACL reconstruction technique avoids creating full-length bone tunnels. Instead, it uses retrograde drilling to form bone sockets, and the graft is secured with adjustable-loop suspensory fixation on both the femur and tibia. |
| Measure | Description | Time Frame |
|---|---|---|
| Tibial Translation | Objective measurement of the anterior tibial translation relative to the femur will be performed using a rolimeter during the Lachman test. | Before surgery, 3rd month, 6th month, 9th month, and 12 month after surgery |
| Pain scale using Visual Analogue Scales | Pain scale on the injured knee, where the minimum value is 0 = no pain, and the maximum value is 100 = severe pain. A higher scale means worse outcomes. | Before surgery, 3rd month, 6th month, 9th month, and 12 month after surgery |
| International Knee Documentation Comittee (IKDC) Score | Knee Function Assessment | Before surgery, 3rd month, 6th month, 9th month, and 12 month after surgery |
| Tegner-Lysholm Score Knee Scoring Scale | a tool to assess knee function | Before surgery, 3rd month, 6th month, 9th month, and 12 month after surgery |
| Hamstring Graft Diameter | The thickness of the hamstring graft after harvesting and folding will be measured using a sizing block with various intra-operative hole sizes | Intra-operative |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Prof. Dr. dr. Andri M.T. Lubis SpOT (K) | Contact | +628161177078 | andri_lubis@yahoo.com |
| Name | Affiliation | Role |
|---|---|---|
| Prof. Dr. dr. Andri M.T. Lubis SpOT (K) | Indonesia University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Indonesian University Hospital | Recruiting | Depok | Indonesia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30888448 | Background | Kouloumentas P, Kavroudakis E, Charalampidis E, Kavroudakis D, Triantafyllopoulos GK. Superior knee flexor strength at 2 years with all-inside short-graft anterior cruciate ligament reconstruction vs a conventional hamstring technique. Knee Surg Sports Traumatol Arthrosc. 2019 Nov;27(11):3592-3598. doi: 10.1007/s00167-019-05456-9. Epub 2019 Mar 19. | |
| 31730379 |
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| Complete Tibial Tunnel techniques | Procedure | Complete Tibial Tunnel Technique is a conventional technique for ACL reconstruction which involves the creation of full-length bone tunnels in the tibia for graft passage via an anterograde approach. Graft fixation is typically achieved using a bio-interference screw on the tibial side and a fixed-loop suspensory device on the femoral side |
|
| Cipto Mangunkusumo Hospital | Recruiting | Jakarta Pusat | Indonesia |
|
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| 29730211 | Background | Meijer K, Saper M, Joyner P, Liu W, Andrews JR, Roth C. Minimizing Graft-Tunnel Mismatch in Allograft Anterior Cruciate Ligament Reconstruction Using Blumensaat's Line: A Cadaveric Study. Arthroscopy. 2018 Aug;34(8):2438-2443.e1. doi: 10.1016/j.arthro.2018.03.006. Epub 2018 May 3. |
| 21866349 | Background | Chiang ER, Ma HL, Wang ST, Hung SC, Liu CL, Chen TH. Hamstring graft sizes differ between Chinese and Caucasians. Knee Surg Sports Traumatol Arthrosc. 2012 May;20(5):916-21. doi: 10.1007/s00167-011-1653-3. Epub 2011 Aug 25. |
| 32913712 | Background | Tang SP, Wan KH, Lee RH, Wong KK, Wong KK. Influence of hamstring autograft diameter on graft failure rate in Chinese population after anterior cruciate ligament reconstruction. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Aug 12;22:45-48. doi: 10.1016/j.asmart.2020.07.005. eCollection 2020 Oct. |
| 26697313 | Background | Colombet P, Graveleau N. An Anterior Cruciate Ligament Reconstruction Technique With 4-Strand Semitendinosus Grafts, Using Outside-In Tibial Tunnel Drilling and Suspensory Fixation Devices. Arthrosc Tech. 2015 Sep 28;4(5):e507-11. doi: 10.1016/j.eats.2015.05.014. eCollection 2015 Oct. |
| 37424637 | Background | Takahashi T, Watanabe S, Ito T. A Surgical Technique for Anterior Cruciate Ligament Reconstruction Using Semitendinosus Graft: An All-Inside Transfemoral Approach. Arthrosc Tech. 2023 May 29;12(6):e975-e982. doi: 10.1016/j.eats.2023.02.035. eCollection 2023 Jun. |
| 29868418 | Background | Jones PE, Schuett DJ. All-Inside Anterior Cruciate Ligament Reconstruction as a Salvage for Small or Attenuated Hamstring Grafts. Arthrosc Tech. 2018 Apr 9;7(5):e453-e457. doi: 10.1016/j.eats.2017.11.007. eCollection 2018 May. |
| 29349014 | Background | Fritsch B, Figueroa F, Semay B. Graft Preparation Technique to Optimize Hamstring Graft Diameter for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2017 Nov 13;6(6):e2169-e2175. doi: 10.1016/j.eats.2017.08.011. eCollection 2017 Dec. |
| Background | Rante SDT, Santoso A, Sibarani T, Utomo DN. All-inside vs. conventional method in anterior cruciate ligament (ACL) reconstruction: systematic review and meta-analysis. Indones J Biomed Sci. 2022;16(2):47-59. |
| 23809454 | Background | Lubowitz JH, Schwartzberg R, Smith P. Randomized controlled trial comparing all-inside anterior cruciate ligament reconstruction technique with anterior cruciate ligament reconstruction with a full tibial tunnel. Arthroscopy. 2013 Jul;29(7):1195-200. doi: 10.1016/j.arthro.2013.04.009. |
| 33241220 | Background | Ashraf Y, Senevirathna SR, Ashraf T. Conventional versus 'all-inside' anterior cruciate ligament reconstruction: a randomized controlled trial comparing hamstring strength and functional outcome. Bone Jt Open. 2020 Nov 4;1(11):706-708. doi: 10.1302/2633-1462.111.BJO-2020-0012.R1. |
| 21663726 | Background | Lubowitz JH, Ahmad CS, Anderson K. All-inside anterior cruciate ligament graft-link technique: second-generation, no-incision anterior cruciate ligament reconstruction. Arthroscopy. 2011 May;27(5):717-27. doi: 10.1016/j.arthro.2011.02.008. |
| 16904591 | Background | Lubowitz JH. No-tunnel anterior cruciate ligament reconstruction: the transtibial all-inside technique. Arthroscopy. 2006 Aug;22(8):900.e1-11. doi: 10.1016/j.arthro.2006.06.003. |
| 8679023 | Background | Morgan CD, Kalmam VR, Grawl DM. Isometry testing for anterior cruciate ligament reconstruction revisited. Arthroscopy. 1995 Dec;11(6):647-59. doi: 10.1016/0749-8063(95)90104-3. |
| 35337306 | Background | Lin R, Zhong Q, Wu X, Cui L, Huang R, Deng Q, Zuo J, Jiang C, Li W. Randomized controlled trial of all-inside and standard single-bundle anterior cruciate ligament reconstruction with functional, MRI-based graft maturity and patient-reported outcome measures. BMC Musculoskelet Disord. 2022 Mar 26;23(1):289. doi: 10.1186/s12891-022-05231-x. |
| 21946441 | Background | Ardern CL, Taylor NF, Feller JA, Webster KE. Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery. Am J Sports Med. 2012 Jan;40(1):41-8. doi: 10.1177/0363546511422999. Epub 2011 Sep 23. |
| 34158018 | Background | Teng Y, Zhang X, Da L, Hu J, Wang H, Han H, Wu M, Zhang S, Xia Y. Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction? A biomechanical study in vitro. BMC Musculoskelet Disord. 2021 Jun 22;22(1):571. doi: 10.1186/s12891-021-04457-5. |
| 34028623 | Background | Goyal T, Das L, Paul S, Choudhury AK, Sethy SS. Outcomes of retro-drilled all-inside tibial tunnel vs complete tibial tunnel techniques in anterior cruciate ligament reconstruction-a comparative study. Eur J Orthop Surg Traumatol. 2022 Apr;32(3):523-532. doi: 10.1007/s00590-021-03011-2. Epub 2021 May 24. |
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| 37762734 | Background | Bosco F, Giustra F, Ghirri A, Cacciola G, Masse A, Capella M. All-Inside Anterior Cruciate Ligament Reconstruction Technique: Tips and Tricks. J Clin Med. 2023 Sep 6;12(18):5793. doi: 10.3390/jcm12185793. |
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| 26550585 | Background | Samitier G, Marcano AI, Alentorn-Geli E, Cugat R, Farmer KW, Moser MW. Failure of Anterior Cruciate Ligament Reconstruction. Arch Bone Jt Surg. 2015 Oct;3(4):220-40. |
| 34604432 | Background | Deviandri R, van der Veen HC, Lubis AMT, Postma MJ, van den Akker-Scheek I. Translation, Cross-Cultural Adaptation, Validity, and Reliability of the Indonesian Version of the IKDC Subjective Knee Form. Orthop J Sports Med. 2021 Sep 29;9(9):23259671211038372. doi: 10.1177/23259671211038372. eCollection 2021 Sep. |
| 35872972 | Background | Deviandri R, van der Veen HC, Lubis AMT, Utoyo GA, van den Akker-Scheek I, Postma MJ. Burden and Cost of Anterior Cruciate Ligament Reconstruction and Reimbursement of Its Treatment in a Developing Country: An Observational Study in Indonesia. Clinicoecon Outcomes Res. 2022 Jul 17;14:479-486. doi: 10.2147/CEOR.S368840. eCollection 2022. |
| ID | Term |
|---|---|
| D000070598 | Anterior Cruciate Ligament Injuries |
| ID | Term |
|---|---|
| D007718 | Knee Injuries |
| D007869 | Leg Injuries |
| D014947 | Wounds and Injuries |
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