Skip to main content

Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique

Knee Surgery, Sports Traumatology, Arthroscopy volume 21, pages 1904–1909 (2013)Cite this article

Abstract

Purpose

Several studies have suggested that drilling the femoral tunnel through an anteromedial arthroscopic portal during anterior cruciate ligament reconstruction allows more anatomic placement of the graft. However, no studies have investigated whether the anteromedial approach results in better outcomes compared to the traditional transtibial drilling approach when a hamstring autograft is used. The purpose of the present study is to investigate short-term functional and clinical outcome differences between male patients recovering from anterior cruciate ligament reconstruction with a hamstring autograft using the transtibial femoral tunnel drilling approach versus the anteromedial approach.

Methods

Lysholm score, functional test and isokinetic data were collected at 3 and 6 months after surgery in 51 male patients who received a standardized rehabilitation in a large outpatient facility. Multivariate and univariate analyses of variance were used to assess group, time and interaction effects.

Results

All outcomes except isokinetic knee flexion at 180°/s improved from 3 to 6 months for both groups (p ≤ 0.05). The anteromedial approach group had better Lysholm scores at 3 months (p ≤ 0.05) and better performance in the timed lateral movement functional tests at 3 and 6 months (p ≤ 0.05). No other comparisons were significant (n.s).

Conclusions

Both groups had comparable outcomes on most measures. The differences in the Lysholm score and lateral movement functional tests may suggest a quicker return of function and performance for the anteromedial approach group. Clinicians should take into consideration the surgical technique as they progress patients recovering from ACL reconstruction through the different phases of the rehabilitation protocol.

Level of evidence

Therapeutic study, Level II.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Alentorn-Geli E, Lajara F, Samitier G, Cugat R (2010) The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18(8):1013–1037

    PubMed  Article  Google Scholar 

  2. Alentorn-Geli E, Samitier G, Alvarez P, Steinbacher G, Cugat R (2010) Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up. Int Orthop 34(5):747–754

    PubMed  Article  Google Scholar 

  3. Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27(3):380–390

    PubMed  Article  Google Scholar 

  4. Bedi A, Raphael B, Maderazo A, Pavlov H, Williams RJ 3rd (2010) Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction: a cadaveric study of femoral tunnel length and obliquity. Arthroscopy 26(3):342–350

    PubMed  Article  Google Scholar 

  5. Bowers AL, Bedi A, Lipman JD, Potter HG, Rodeo SA, Pearle AD, Warren RF, Altchek DW (2011) Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging. Arthroscopy 27(11):1511–1522

    PubMed  Article  Google Scholar 

  6. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR (2009) The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 37(5):890–897

    PubMed  Article  Google Scholar 

  7. Chang CB, Choi J-Y, Koh IJ, Lee KJ, Lee K-H, Kim TK (2011) Comparisons of femoral tunnel position and length in anterior cruciate ligament reconstruction: modified transtibial versus anteromedial portal techniques. Arthroscopy 27(10):1389–1394

    PubMed  Article  Google Scholar 

  8. Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17(3):220–227

    PubMed  Article  Google Scholar 

  9. Ganko A, Engebretsen L, Ozer H (2000) The Rolimeter: a new arthrometer compared with the KT-1000. Knee Surg Sports Traumatol Arthrosc 8(1):36–39

    PubMed  Article  CAS  Google Scholar 

  10. Gavriilidis I, Motsis EK, Pakos EE, Georgoulis AD, Mitsionis G, Xenakis TA (2008) Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study. Knee 15(5):364–367

    PubMed  Article  Google Scholar 

  11. Georgoulis A, Ristanis S, Moraiti C, Paschos N, Zampeli F, Xergia S, Georgiou S, Patras K, Vasiliadis H, Mitsionis G (2010) ACL injury and reconstruction: clinical related in vivo biomechanics. Orthop Traumatol Surg Res 96(8 Suppl):S119–S128

    PubMed  Article  CAS  Google Scholar 

  12. Hantes ME, Zachos VC, Liantsis A, Venouziou A, Karantanas AH, Malizos KN (2009) Differences in graft orientation using the transtibial and anteromedial portal technique in anterior cruciate ligament reconstruction: a magnetic resonance imaging study. Knee Surg Sports Traumatol Arthrosc 17(8):880–886

    PubMed  Article  Google Scholar 

  13. Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM (2001) The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 29(5):567–574

    PubMed  CAS  Google Scholar 

  14. Keays SL, Bullock-Saxton J, Keays AC (2000) Strength and function before and after anterior cruciate ligament reconstruction. Clin Orthop Relat Res 373:174–183

    PubMed  Article  Google Scholar 

  15. Keays SL, Bullock-Saxton JE, Newcombe P, Keays AC (2003) The relationship between knee strength and functional stability before and after anterior cruciate ligament reconstruction. J Orthop Res 21(2):231–237

    PubMed  Article  CAS  Google Scholar 

  16. Koutras G, Letsi M, Papadopoulos P, Gigis I, Pappas E (2012) A randomized trial of isokinetic versus isotonic rehabilitation program after arthroscopic meniscectomy. Int J Sports Phys Ther 7(1):31–38

    PubMed  Google Scholar 

  17. Koutras G, Pappas E, Terzidis IP (2009) Crossover Training Effects of Three Different Rehabilitation Programs After Arthroscopic Meniscectomy. Int J Sports Med 30(2):144–149

    PubMed  Article  CAS  Google Scholar 

  18. Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50(10):3145–3152

    PubMed  Article  CAS  Google Scholar 

  19. McRae SM, Chahal J, Leiter JR, Marx RG, Macdonald PB (2011) Survey study of members of the Canadian Orthopaedic Association on the natural history and treatment of anterior cruciate ligament injury. Clin J Sport Med 21(3):249–258

    PubMed  Article  Google Scholar 

  20. Myer GDSL, Brent JL, Ford KR, Barber Foss KD, Scherer BJ, Heidt RS Jr, Divine JG, Hewett TE (2011) Utilization of modified NFL combine testing to identify functional deficits in athletes following acl reconstruction. J Orthop Sports Phys Ther 41(6):377–387

    PubMed  Google Scholar 

  21. Pappas E, Zampeli F, Xergia S, Georgoulis A (2012) Lessons learned from the last 20 years of ACL-related in vivo-biomechanics research of the knee joint. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-1955-0

    Google Scholar 

  22. Roos EM (2005) Joint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol 17(2):195–200

    PubMed  Article  Google Scholar 

  23. Ruiz AL, Kelly M, Nutton RW (2002) Arthroscopic ACL reconstruction: a 5–9 year follow-up. Knee 9(3):197–200

    PubMed  Article  CAS  Google Scholar 

  24. Shaw T, Chipchase LS, Williams MT (2004) A users guide to outcome measurement following ACL reconstruction. Phys Ther Sport 5(2):57–67

    Google Scholar 

  25. Shelbourne KD, Gray T (1997) Anterior Cruciate Ligament Reconstruction with Autogenous Patellar Tendon Graft Followed by Accelerated Rehabilitation. Am J Sports Med 25(6):786–795

    PubMed  Article  CAS  Google Scholar 

  26. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    PubMed  Google Scholar 

  27. Wagner L, Thillemann T, Mehnert F, Pedersen A, Lind M (2012) Increased risk of ACL revision after anteromedial compared to transtibial technique for femoral drill hole placement during ACL reconstruction Result from the Danish registry of knee ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20(Suppl 1):2

    Google Scholar 

  28. Zampeli F, Ntoulia A, Giotis D, Tsiaras VA, Argyropoulou M, Pappas E, Georgoulis AD (2012) Correlation between anterior cruciate ligament graft obliquity and tibial rotation during dynamic pivoting activities in patients with anatomic anterior cruciate ligament reconstruction: an in vivo examination. Arthroscopy 28(2):234–246

    PubMed  Article  Google Scholar 

  29. Zampeli F, Pappas E, Giotis D, Hantes M, Georgoulis A (2012) Kinematic predictors of subjective outcome after anterior cruciate ligament reconstruction: an in vivo motion analysis study. Knee Surg Sports Traumatol Arthrosc 20(4):785–792

    PubMed  Article  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Physical Therapy, Technological Education Institute of Thessaloniki, Thessaloniki, Greece

    Georgios Koutras

  2. Department of Orthopaedics, General Hospital Papanikolaou, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Pericles Papadopoulos

  3. St. Loukas General Hospital, Thessaloniki, Greece

    Ioannis P. Terzidis

  4. 2nd Orthopaedic Department, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Ioannis Gigis

  5. Department of Physical Therapy, Long Island University-Brooklyn Campus, 1 University Plaza, HS 219, Brooklyn, NY, 11201, USA

    Evangelos Pappas

Authors
  1. Georgios Koutras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pericles Papadopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ioannis P. Terzidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ioannis Gigis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Evangelos Pappas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Evangelos Pappas.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Koutras, G., Papadopoulos, P., Terzidis, I.P. et al. Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 21, 1904–1909 (2013). https://doi.org/10.1007/s00167-012-2323-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2323-9

Keywords

  • Femoral tunnel drilling
  • Anatomic ACL reconstruction
  • Rotational instability
  • Rehabilitation outcomes