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Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

In anterior cruciate ligament (ACL) reconstruction, there is concern regarding the potential risk of femoral tunnel widening in the anteromedial portal (AMP) technique due to the acute graft-bending angle at the aperture and the more elliptical aperture shape of the femoral tunnel compared to the transtibial (TT) techniques. Therefore, the aim of the current systematic review and meta-analysis was to compare the femoral tunnel widening between the AMP and TT techniques in patients who underwent ACL reconstruction.

Methods

It should be included the studies that reported on femoral tunnel widening in patients who underwent single-bundle ACL reconstruction, using soft-tissue tendon graft, with AMP and/or TT techniques. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACL reconstruction.

Results

Twenty-one studies were finally included in this meta-analysis. The pooled changes of absolute millimeters of tunnel widening from the immediate postoperative status to the last follow-up did not differ significantly between the AMP and TT techniques at both the aperture [3.31 mm, 95% confidence interval (CI) 1.7–5.0. mm versus 2.9 mm, 95% CI 2.4–3.4 mm, P = n.s.] and the midportion (3.5 mm, 95% CI 0.8–6.3 mm versus 3.0 mm, 95% CI 2.2–3.9 mm, P = n.s.) of the femoral tunnel. No significant difference was observed between the two techniques in the relative percentage of femoral tunnel widening (AMP; 28.8%, 95% CI 14.8–42.9% vs. TT; 29.7%, 95% CI 15.6–43.7%, P = n.s.).

Conclusion

No significant difference in femoral tunnel widening was observed between the AMP and TT techniques, both in absolute millimeter and relative percentage, in patients who underwent single-bundle ACL reconstruction. This finding could alleviate the potential concerns associated with femoral tunnels being wider for the AMP than for the TT technique.

Level of evidence

III.

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Funding

This study was supported by SMC-Ottogi Research Fund (SMX1162171).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, College of Medicine, Gangneung Asan Hospital, Ulsan University, Gangneung, Republic of Korea

    Ho Jong Ra

  2. Department of Orthopaedic Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey

    Haluk Celik

  3. Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, 06351, Seoul, South Korea

    Hyun-Jun Kim & Dae-Hee Lee

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  1. Ho Jong Ra
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Correspondence to Dae-Hee Lee.

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Ra, H.J., Celik, H., Kim, HJ. et al. Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 27, 626–635 (2019). https://doi.org/10.1007/s00167-018-5204-z

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