A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up
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The purpose of this study was to compare clinical and radiological outcomes of patients who underwent single-bundle anterior cruciate ligament (ACL) reconstruction with anteromedial portal (AMP) and transtibial (TT) techniques.
Materials and methods
Arthroscopic single-bundle ACL reconstruction was performed using AMP technique in 34 patients and TT technique in 30 patients. The patients were evaluated retrospectively. Aperture fixation was used for femoral fixation, and absorbable screws and U staples were used for tibial fixation of the graft. Pivot shift test, Lachman test, Lysholm, Tegner, and International Knee Documentation Committee (IKDC-2000) scoring systems were used in the clinical and functional evaluation of patients before and after the surgery. Time to return sports and activity level were assessed. In the radiological evaluation of non-anatomic bone tunnel placement, the criteria developed by lllingworth et al. were used. The mean duration of follow-up was 20.4 and 24.6 months in the AMP and TT groups, respectively.
There was a significant difference between the AMP group (86.7 %) and the TT (14.7 %) group in terms of anatomical placement of the femoral tunnels and grafts (p < 0.001). No significant difference was observed between the two groups in terms of the Pivot shift test, Lachman test, Lysholm, Tegner, and IKDC scores, and activity level (p > 0.05). The patients in the AMP group returned to sports 1.5 months earlier on average (p < 0.001).
It was shown that AMP technique was superior to the TT technique in providing anatomical placement of the graft and in recovery time to return sports; however, there was no difference between groups in early periods in terms of the clinical and functional outcomes.
KeywordsAnatomical reconstruction Anterior cruciate ligament Anteromedial portal Transtibial technique Single bundle
Authors thanks to Dr. Ebubekir Şenates for his contribution to this study.
Conflict of interest
- 9.Abebe ES, Moorman CT 3rd, Dziedzic TS, Spritzer CE, Cothran RL, Taylor DC et al (2009) Femoral tunnel placement during anterior cruciate ligament reconstruction: an in vivo imaging analysis comparing transtibial and 2-incision tibial tunnelindependent techniques. Am J Sports Med 37(10):1904–1911Google Scholar
- 11.Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH (2010) Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 92:1427–1431PubMedCentralPubMedCrossRefGoogle Scholar
- 28.Fuu FH, Bennett CH, Ma CB, Menetrey J, Lattermann C (2000) Current trends in anterior cruciate ligament reconstruction. Part II operative procedures and clinical correlations. Am J Sports Med 28:124–130Google Scholar
- 29.Zhang C, Xu H, Li X, Wang Y, Zhang Q, Zhu Q (2013) Oblique femoral tunnel or oblique graft? A modified anteromedial portal technique to obtain vertical femoral tunnel and oblique graft in anatomic anterior cruciate ligament reconstruction. Eur J Orthop Surg Traumatol 23:731–735PubMedCrossRefGoogle Scholar
- 31.Otani M, Nozaki M, Kobayashi M, Goto H, Tawada K, Waguri-Nagaya Y et al (2012) Comparative risk of common peroneal nerve injury in far anteromedial portal drilling and transtibial drilling in anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 20:896–903CrossRefGoogle Scholar