Endoscopic versus rear-entry ACL reconstruction - A systematic review

Anterior cruciate ligament reconstruction is commonly performed using the all-endoscopic (also known as all-inside or single-incision) method or the rear-entry (also known as outside-in or two-incision) method. We report a systematic review of four prospective, randomized clinical trials comparing these two operative techniques. Operative time was shorter in the all-endoscopic groups in two studies. A higher percentage of patients in the rear-entry group had a difference of 3 mm or less on the KT-2000 arthrometer, although the two surgical techniques were similar in the other studies. A higher rate of return to full activity was achieved in patients undergoing the rear-entry technique in one study. All four studies were similar in pain medication used, progression of rehabilitation, range of motion, quadriceps or hamstring strength, patellofemoral pain, one-leg hop test, Lyshohn, Tegner, and International Knee Documentation Committee scores. Overall, these studies show similar outcomes comparing the all-endoscopic and rear-entry anterior cruciate ligament reconstruction techniques. Level of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.