Is Anterior Cruciate Ligament Reconstruction "Silva Technique" Equal to All-Inside Techniques? A Prospective Single-Center Study: An Alternative ACL All-Inside Reconstruction Technique Using a Tibial Tunnel and Bone Graft.

Background: The development of less invasive all-inside techniques regarding anterior cruciate ligament (ACL) reconstruction surgery has been associated with various advantages, including fewer complications and reduced postoperative pain. Silva et al. described a quadruple semitendinosus graft construct and suspensory button fixation for ACL reconstruction as an alternative technique. At the end of this technique, the tibial tunnel is filled with a bone autograft plug. This paper aims to examine the incorporation of the autograft and thus evaluate whether the "Silva technique" provides the same benefits as all-inside techniques. Methods: A prospective study assessed 31 patients undergoing ACL reconstruction surgery using the "Silva technique." The cases involved in the study were skeletally mature patients with no previous history of ACL surgery or multiligamentous instability. All patients followed the same rehabilitation program and were examined at three standardized follow-up visits: 4 months, 8 months, and 1 year postoperatively. Tegner-Lysholm knee score (TLKS), visual analog score (VAS) for pain, and the IKDC subjective knee score were completed at every visit. A knee MRI scan was performed at every scheduled visit to assess bone graft incorporation and remodeling. Results: TLKS scores revealed a considerable improvement compared to preoperative figures, from 57.2 points preoperatively to an average of 99.4 at the 12-month follow-up (p < 0.0001). VAS scores were substantially ameliorated after the operation and until the second follow-up visit, from 5 before surgery to zero 8 months after the operation, with no noteworthy alterations afterward (p < 0.0001). IKDC subjective knee score outcomes were found to have increased at the last follow-up, from 59.3 prior to surgery to 99.8 12 months postoperatively (p < 0.0001). Regarding the MRI features of the bone autograft, the tibial tunnel was entirely filled by bone formation at the last MRI scan, suggesting complete integration of the autograft in all patients. Conclusions: Bone autograft employed to seal the tibial tunnel was completely incorporated in all cases 1 year postoperatively. The "Silva technique" appears to feature all the avails of all-inside techniques, whilst it seems to be simpler and easier than them after the surgeon is familiarized with its particular aspects. It is a robust option in orthopedic surgeons' arsenal. However, further large-scale pertinent research is requisite to confirm the findings of this study.