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No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction: a prospective randomized, controlled trial

Knee Surgery, Sports Traumatology, Arthroscopy volume 26, pages 1335–1342 (2018)Cite this article

Abstract

Purpose

The anteromedial (AMP) portal technique was introduced to position the femoral tunnel in anterior cruciate ligament (ACL) reconstruction to more closely replicate the original ACL footprint compared to the transtibial (TT) approach. Few randomized trials have evaluated differences in these techniques with respect to clinical outcomes. The purpose of this study was to determine if there are any differences in clinical outcome between the AMP and TT approaches.

Methods

This is a single-blinded, prospective, randomized controlled trial. Participants were randomized to undergo ACL reconstruction using the AMP or TT approach. The primary outcome measure was the ACL quality of life (ACL-QOL), and secondary outcomes were the IKDC knee assessment, side-to-side difference in anterior–posterior knee laxity (KT-1000) and tunnel orientation (X-ray findings) at preoperative, 3, 6, 12, and 24 months postoperative. Statistical comparisons were performed using a series of t tests for independent groups with equal variance.

Results

Ninety-six participants were consented and randomized between 2007 and 2011 with eight excluded postrandomization. Mean (SD) preoperative ACL-QOL was 33 (13) for TT and 36 (17) for AMP and improved significantly (p < 0.001) in both groups to 79 (18) and 78 (18) at 24 months postoperative, respectively. The preoperative median IKDC grade for both groups was C and improved similarly in both groups at 24 months (n.s.). There was no side-to-side difference in knee laxity based on KT-1000 measurements with a mean (SD) 1 (3) mm between affected and unaffected limbs in the TT group compared to 1 (3) mm for the AMP group. A significant difference was found in femoral tunnel orientation with the AMP group at 43° (7) and the TT group 58° (8) in the coronal plane (p < 0.001).

Conclusion

No differences in clinical outcome were found when comparing AMP to TT in primary ACL reconstruction using a STG graft. This prospective randomized controlled trial suggests surgeons can use either method without significantly compromising clinical outcome.

Level of evidence

I.

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Acknowledgements

The authors would like to thank Treny Sasyniuk for her valuable contributions to this project.

Author information

Affiliations

  1. Department of Surgery, Pan Am Clinic, University of Manitoba, Orthopaedics 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada

    Peter MacDonald, Chris Kim, Sheila McRae & Jeff Leiter

  2. St. Michael’s Hospital, St. Michael’s Orthpaedic Associates, 55 Queen St E., Suite 800, Toronto, ON, M5C 1R6, Canada

    Ryan Khan & Daniel Whelan

Authors
  1. Peter MacDonald
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  2. Chris Kim
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Correspondence to Peter MacDonald.

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Conflict of interest

The authors declare that they have no competing interests.

Funding

Funding for this study was provided by the University of Manitoba Alexander Gibson Fund.

Ethical approval

This study was approved by the University of Manitoba Biomedical Research Ethics Board and the St. Michael's Hospital Research Ethics Board and was performed in accordance with the Declaration of Helsinki (developed by the World Medical Association in 1964; seventh revision in 2013).

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MacDonald, P., Kim, C., McRae, S. et al. No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction: a prospective randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 26, 1335–1342 (2018). https://doi.org/10.1007/s00167-017-4664-x

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  • DOI: https://doi.org/10.1007/s00167-017-4664-x

Keywords

  • Anterior cruciate ligament
  • Reconstruction
  • Semitendinosus
  • Gracilis
  • Anteromedial
  • Trans-tibial
  • Tibial tunnel independent