Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation

Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2577-2584. doi: 10.1007/s00167-018-5275-x. Epub 2018 Nov 7.


Purpose: To compare clinical outcomes and tunnel widening following anterior cruciate ligament reconstruction (ACLR) performed with an all-inside technique (Group A) or with a bioabsorbable tibial screw and suspensory femoral fixation (Group B).

Methods: Tunnel widening was assessed using computed tomography (CT) and a previously validated analytical best fit cylinder technique at approximately 1-year following ACLR. Clinical follow-up comprised evaluation with IKDC, KSS, Tegner, Lysholm scores, and knee laxity assessment.

Results: The study population comprised 22 patients in each group with a median clinical follow-up of 24 months (range 21-27 months). The median duration between ACLR and CT was 13 months (range 12-14 months). There were no significant differences in clinical outcome measures between groups. There were no differences between groups with respect to femoral tunnel widening. However, there was a significantly larger increase in tibial tunnel widening, at the middle portion, in Group B (2.4 ± 1.5 mm) compared to Group A (0.8 ± 0.4 mm) (p = 0.027), and also at the articular portion in Group B (1.5 ± 0.8 mm) compared to Group A (0.8 ± 0.8 mm) (p = 0.027).

Conclusion: Tibial tunnel widening after ACLR using hamstring tendon autograft is significantly greater with suspensory femoral fixation and a bioabsorbable tibial interference screw when compared to an all-inside technique at a median follow-up of 2 years. The clinical relevance of this work lies in the rebuttal of concerns arising from biomechanical studies regarding the possibility of increased tunnel widening with an all-inside technique.

Level of evidence: III.

Keywords: ACL reconstruction; All-inside; Bioabsorbable screw; Retrograde drilling; Tunnel widening.

Publication types

  • Comparative Study

MeSH terms

  • Absorbable Implants
  • Adult
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries / surgery
  • Anterior Cruciate Ligament Reconstruction / adverse effects*
  • Anterior Cruciate Ligament Reconstruction / instrumentation
  • Anterior Cruciate Ligament Reconstruction / methods
  • Bone Screws
  • Female
  • Femur / surgery
  • Hamstring Tendons / transplantation
  • Humans
  • Knee Joint / surgery*
  • Male
  • Retrospective Studies
  • Tibia / diagnostic imaging
  • Tibia / surgery*
  • Tomography, X-Ray Computed
  • Transplantation, Autologous