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Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction

Knee Surgery, Sports Traumatology, Arthroscopy volume 25, pages 2751–2759 (2017)Cite this article

Abstract

Purpose

The clinical outcomes of transtibial (TT) and anteromedial (AM) drilling techniques for anterior cruciate ligament reconstruction in preparing the femoral tunnel were directly compared by using a systematic literature review.

Methods

PubMed, EMBASE, the Cochrane Library, and the ISI Web of Science were searched until 10 May 2014, using the following Boolean operators: transtibial AND (anteromedial OR transportal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. All prospective and retrospective controlled trials directly comparing physical examination and scoring system results between TT and AM techniques were retrieved. No language or publication year limitations were used in our analysis.

Results

Of 504 studies retrieved, nine studies involving 769 patients were included. Results suggested that the AM was superior to the TT technique for preparing the femoral tunnel independent of the International Knee Documentation Committee (IKDC) Score (n.s.). A higher proportion of negative Lachman (p = 0.002) and pivot-shift test (p = 0.01) results, lower manual maximum displacement by KT-1000 (p = 0.004), higher Lysholm scores (p = 0.034), a higher incidence of IKDC grade A/B (p = 0.04), and higher visual analogue scale scores (p = 0.00) were observed with the AM compared with the TT technique.

Conclusion

Although the increases in these scores were below the minimal clinically important difference, this systematic review indicated that the AM was superior to the TT drilling technique based on physical examination and scoring system results.

Level of evidence

Therapeutic study (systematic review), Level III.

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Acknowledgments

The study was supported by the National Natural Science Foundation of China (81171687).

Conflict of interest

There was no conflict of interest existing for any author in our research.

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Author notes

    Affiliations

    1. Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

      An Liu, Chiyuan Ma, Yunlin Chen, Xinghe Xue, Peng Guo, Zhongli Shi & Shigui Yan

    2. Department of Oral and Maxillofacial Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

      Miao Sun

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    1. An Liu
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    Correspondence to Shigui Yan.

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    An Liu and Miao Sun are co-first authors and they contributed equally to the work.

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    Liu, A., Sun, M., Ma, C. et al. Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 25, 2751–2759 (2017). https://doi.org/10.1007/s00167-015-3672-y

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    Keywords

    • Transtibial
    • Anteromedial
    • Femoral tunnel
    • Anterior cruciate ligament reconstruction