# Management and analysis of complications associated with all‐inside technique anterior cruciate ligament reconstruction: A propensity score‐matched study

## TL;DR

This study examines complications from a specific ACL reconstruction technique and finds that managed complications do not significantly affect long-term knee outcomes.

## Contribution

The study introduces a propensity score-matched analysis to evaluate the impact of complications in all-inside ACL reconstruction.

## Key findings

- 16.4% of patients experienced AIT-related complications, but most were resolved or managed without affecting outcomes.
- Knee function and stability were comparable between patients with and without complications after 24 months.
- Technical vigilance and intraoperative management are emphasized to optimize surgical results.

## Abstract

To investigate the incidence and management of complications associated with all‐inside technique (AIT) anterior cruciate ligament reconstruction (ACLR), and to compare postoperative outcomes between patients with successfully managed complications and complication‐free controls.

A retrospective analysis was conducted on patients undergoing AIT‐ACLR. AIT‐related complications were documented, with a minimum 24‐month follow‐up. Propensity score matching (PSM, 1:2 ratio) was used to compare the complication and non‐complication groups. Knee function was assessed using the Lysholm Knee Score, International Knee Documentation Committee Subjective Score, and Tegner Activity Scale. Stability was measured with the Ligs Digital Arthrometer.

A total of 274 patients were included, with 45 patients (16.4%) experiencing AIT‐related complications. Complications comprised tibial lateral subluxation (21 cases, 7.7%; mean displacement: 2.3 mm, range 2.0–2.5 mm), which resolved spontaneously in 4 patients (19.1%) by 1 month postoperatively and in the remaining cases by 3 months. Femoral suspensory button malposition occurred in 12 patients (4.4%), with only one case (8.3%) requiring immediate revision due to a 7.6 mm displacement. The others (mean displacement: 2.5 mm, range 2.1–3.0 mm) were managed conservatively. Cortical breach at the tibial tunnel exit (7 cases, 2.6%) and flip drill bit breakage (5 cases, 1.8%) were addressed intraoperatively. Following PSM (complication group: n = 45 vs. non‐complication group: n = 87), baseline demographics demonstrated no significant differences except for operative time (p = 0.035). There were no statistically significant differences in knee function and stability between the matched groups at 3, 6, 12, and 24 months postoperatively (p > 0.05 for all).

Postoperative knee function and stability demonstrated improvement following AIT‐ACLR. Although appropriately managed complications did not substantially compromise clinical outcomes, the findings emphasize the importance of technical vigilance, intraoperative complication management, and preventive strategies to optimize surgical outcomes.

Level III, case‐control study.