Pain evaluation after all-inside anterior cruciate ligament reconstruction and short term functional results of a prospective randomized study

Purpose: To assess post-operative pain in patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction by the all-inside technique. Methods: A prospective randomized comparative parallel trial was performed in 2010-2011 including all patients who underwent an ACL reconstruction in an orthopaedic department in accordance with the CONSORT statement 2010. Patients were randomized to the surgical procedure, all-inside or classical, and were blinded to the surgical technique. Primary evaluation criterion was pain assessed on the Visual Analogical Scale 1 month after surgery. Secondary parameters were analgesic consumption, tunnel positioning on X-ray according to Aglietti's criteria and functional evaluation at six months with IKDC score. None of the patients was lost to follow-up. Results: 46 consecutive patients were included, 23 in each group, mean age 29.3 +/- 9 years. Two patients were excluded due to postoperative complications that required early revision surgery. Forty-four patients were analyzed, 22 in each group. At one month, the pain level was 3.2 +/- 5.5 for the all-inside group and 8.6 +/- 10 for the classical group, p = 0.057 (95%CI 0.5-10.4). Postoperative analgesic consumption was similar. The position of the tibial tunnels was better with the all-inside method, p = 0.002 (95%CI 1.9-6.6%). There was no significant difference in the mean IKDC subjective score at six months, p = 0.92 (95%CI-9.7 to 92). Conclusion: At one month, the pain level seemed lower in the all-inside group than in the classical group, at the limit of statistical significance because the study was underpowered. The all-inside technique is a reliable procedure with very good results for pain, stability and knee function. Level of evidence: I; Therapeutic study. (C) 2013 Elsevier B.V. All rights reserved.