ArticleFrontiers in surgery2025
Arthroscopic all-inside ACL reconstruction with anterolateral tendon fixation: a prospective cohort study on restoring rotational stability in high-grade tibial shift.
Article in Frontiers in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aim: This 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). Methods: In 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. Results: All 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 ( Conclusion: Combined 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.
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