Skip to main content

Advertisement

SpringerLink
Log in

Similar outcomes and satisfaction after transtibial versus transportal femoral drilling for anterior cruciate ligament reconstruction in young adult recreational athletes

  • KNEE
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Controversy continues regarding whether the transtibial (TT) and transportal (TP) methods for anterior cruciate ligament (ACL) reconstruction provide similar or different outcomes, and the evidence on patient satisfaction is very limited. The objective of this study was to compare functional outcomes and patient satisfaction in young adult recreational athletes who underwent arthroscopic hamstring ACL reconstruction using either the TT or the TP femoral tunnel drilling method.

Methods

A nonrandomized prospective study was designed to compare the outcomes of arthroscopic hamstring ACL reconstruction using TT or TP method. Functional outcome was assessed with the Lyshom score, and patient satisfaction with a 5-point Likert scale. Knee stability was measured with the KT-1000 arthrometer.

Results

42 patients in the TT group and 41 in TP group, with age ranged 18–40 years, were compared with a mean follow-up of 42 (range 24–60) months. There were no significant differences between groups in the Lysholm score (n.s.), sport return rate (n.s.) or patient satisfaction with the surgery (n.s.). Satisfaction was only significantly associated with the Lysholm score (OR 1.3; IC 95% 1.06–1.6; p = 0.012), but not with the return to sports (n.s.) or knee anterior laxity (n.s.).

Conclusion

This study showed no statistical differences between the TT and the TP method in functional outcomes or patient satisfaction in young adult recreational athletes. In those patients, satisfaction with the surgery was not influenced by the return to sport activities. This study can guide surgeons in the decision-making for ACL reconstruction in recreational athletes.

Level of evidence

Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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 34:747–754

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ardern CL, Taylor NF, Feller JA, Whitehead TS, Webster KE (2015) Sports participation 2 years after anterior cruciate ligament reconstruction in athletes who had not returned to sport at 1 year: a prospective follow-up of physical function and psychological factors in 122 athletes. Am J Sports Med 43:848–856

    Article  PubMed  Google Scholar 

  3. Azboy I, Demirtaş A, Gem M, Kıran S, Alemdar C, Bulut M (2014) A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up. Arch Orthop Trauma Surg 134:963–969

    Article  PubMed  Google Scholar 

  4. 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 27:380–390

    Article  PubMed  Google Scholar 

  5. Bhardwaj A, Solanki NS, Jain H, Raichandani K, Raichandani S, Daruwalla V (2018) Comparison of outcome after ACL reconstruction in terms of subjective assessment of symptoms and function and clinical assessment of ligament stability. J Clin Orthop Trauma 9:72–174

    Google Scholar 

  6. Bohn MB, Sørensen H, Petersen MK, Søballe K, Lind M (2015) Rotational laxity after anatomical ACL reconstruction measured by 3-D motion analysis: a prospective randomized clinical trial comparing anatomic and nonanatomic ACL reconstruction techniques. Knee Surg Sports Traumatol Arthrosc 23:3473–3481

    Article  PubMed  Google Scholar 

  7. 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 37:890–897

    Article  PubMed  Google Scholar 

  8. Burgi CR, Peters S, Ardern CL, Magill JR, Gomez CD, Sylvain J, Reiman MP (2019) Which criteria are used to clear patients to return to sport after primary ACL reconstruction? A scoping review. Br J Sports Med 53:1154–1161

    Article  PubMed  Google Scholar 

  9. Chen H, Tie K, Qi Y, Li B, Chen B, Chen L (2017) Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials. J Orthop Surg Res 12:167

    Article  PubMed  PubMed Central  Google Scholar 

  10. Clatworthy M, Sauer S, Roberts T (2019) Transportal central femoral tunnel placement has a significantly higher revision rate than transtibial AM femoral tunnel placement in hamstring ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27:124–129

    Article  PubMed  Google Scholar 

  11. Courtot L, Ferre F, Reina N, Marot V, Chiron P, Berard E, Cavaignac E (2019) Patient participation during anterior cruciate ligament reconstruction improves comprehension, satisfaction, and functional outcomes: a simple way to improve our practices. Orthop J Sports Med 7:2325967119841089. https://doi.org/10.1177/2325967119841089

    Article  PubMed  PubMed Central  Google Scholar 

  12. Failla MJ, Logerstedt DS, Grindem H, Axe MJ, Risberg MA, Engebretsen L et al (2016) Does extended preoperative rehabilitation influence outcomes 2 Years after ACL reconstruction? A comparative effectiveness study between the MOON and Delaware-Oslo ACL cohorts. Am J Sports Med 44:2608–2614

    Article  PubMed  PubMed Central  Google Scholar 

  13. Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS (2010) A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 363:331–342

    Article  CAS  PubMed  Google Scholar 

  14. Geng Y, Gai P (2018) Comparison of 2 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction: a prospective randomized comparative study. BMC Musculoskelet Disord 19:454. https://doi.org/10.1186/s12891-018-2376-0

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gupta R, Kapoor A, Soni A, Khatri S, Masih GD (2020) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft is associated with higher and earlier return to sports as compared to hamstring tendon graft. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06074-6

    Article  PubMed  Google Scholar 

  16. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520

    Article  PubMed  Google Scholar 

  17. Hussin EA, Aldaheri A, Alharbi H, Farouk HA (2018) Modified transtibial versus anteromedial portal techniques for anterior cruciate ligament reconstruction: a comparative study. Open Access J Sports Med 9:199. https://doi.org/10.2147/OAJSM.S157729

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kahlenberg CA, Nwachukwu BU, Ferraro RA, Schairer WW, Steinhaus ME, Allen AA (2016) How are we measuring patient satisfaction after anterior cruciate ligament reconstruction? Orthop J Sports Med 4:2325967116673971. https://doi.org/10.1177/2325967116673971

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kitaguchi T, Tanaka Y, Takeshita S, Tsujimoto N, Kita K, Amano H, Kinugasa K, Tachibana Y, Natsuume T, Horibe S (2020) Importance of functional performance and psychological readiness for return to preinjury level of sports 1 year after ACL reconstruction in competitive athletes. Knee Surg Sports Traumatol Arthrosc 28:2203–2212

    Article  PubMed  Google Scholar 

  21. Kocher MS, Steadman JR, Briggs K, Zurakowski D, Sterett WI, Hawkins RJ (2002) Determinants of patient satisfaction with outcome after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 84-A:1560–1572

    Article  Google Scholar 

  22. Koutras G, Papadopoulos P, Terzidis IP, Gigis I, Pappas E (2013) 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

    Article  PubMed  Google Scholar 

  23. Lai CC, Ardern CL, Feller JA, Webster KE (2018) Eighty-three per cent of elite athletes return to preinjury sport after anterior cruciate ligament reconstruction: a systematic review with metaanalysis of return to sport rates, graft rupture rates and performance outcomes. Br J Sports Med 52:128–138

    Article  PubMed  Google Scholar 

  24. Legnani C, Peretti GM, Del Re M, Borgo E, Ventura A (2019) Return to sports and re-rupture rate following anterior cruciate ligament reconstruction in amateur sportsman: long-term outcomes. J Sports Med Phys Fitness 59:1902–1907

    PubMed  Google Scholar 

  25. Liu A, Sun M, Ma C, Chen Y, Xue X, Guo P, Shi Z, Yan S (2017) 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

    Article  PubMed  Google Scholar 

  26. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154

    Article  CAS  PubMed  Google Scholar 

  27. MacDonald P, Kim C, McRae S, Leiter J, Khan R, Whelan D (2018) 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

    Article  PubMed  Google Scholar 

  28. Mardani-Kivi M, Madadi F, Keyhani S, Karimi-Mobarake M, Hashemi-Motlagh K, Saheb-Ekhtiari K (2012) Antero-medial portal vs. transtibial techniques for drilling femoral tunnel in ACL reconstruction using 4-strand hamstring tendon: a cross-sectional study with 1-year follow-up. Med Sci Monit 18:674–679

    Article  Google Scholar 

  29. Minguell J, Núñez J, Reverte M, Sallent A, Gargallo A, Castellet E (2019) Femoral tunnel position in chronic anterior cruciate ligament rupture reconstruction: randomized controlled trial comparing anatomic, biomechanical and clinical outcomes. Eur J Orthop Surg 29:1501–1509

    Article  Google Scholar 

  30. Minzlaff P, Heidt T, Feucht MJ, Plath JE, Hinterwimmer S, Imhoff AB, Saier T (2018) Patient satisfaction with health is substantially improved following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 26:582–588

    Article  PubMed  Google Scholar 

  31. Mohtadi NG, Chan DS (2018) Return to sport-specific performance after primary anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med 46:3307–3316

    Article  PubMed  Google Scholar 

  32. Moorthy V, Sayampanathan AA, Chye Tan AH (2020) Superior postoperative stability and functional outcomes with anteromedial vs transtibial technique of single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomised controlled trials. Arthroscopy. https://doi.org/10.1016/j.arthro.2020.07.018

    Article  PubMed  Google Scholar 

  33. Nwachukwu BU, Voleti PB, Berkanish P, Chang B, Cohn MR, Williams RJ 3rd, Allen AA (2017) Return to play and patient satisfaction after ACL reconstruction: study with minimum 2-year follow-up. J Bone Joint Surg Am 99-A:720–725

    Article  Google Scholar 

  34. Rahardja R, Zhu M, Love H, Clatworthy MG, Monk AP, Young SW (2020) No difference in revision rates between anteromedial portal and transtibial drilling of the femoral graft tunnel in primary anterior cruciate ligament reconstruction: early results from the New Zealand ACL Registry. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05959-w

    Article  PubMed  Google Scholar 

  35. Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind MC (2013) Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Register. Arthroscopy 29:98–105

    Article  PubMed  Google Scholar 

  36. Riboh JC, Hasselblad V, Godin JA, Mather RC 3rd (2013) Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis and meta-regression. Am J Sports Med 41:2693–2702

    Article  PubMed  Google Scholar 

  37. Ro KH, Kim HJ, Lee DH (2018) The transportal technique shows better clinical results than the transtibial techniques for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:2371–2380

    Article  PubMed  Google Scholar 

  38. Senorski EH, Samuelsson K, Thomeé C, Beischer S, Karlsson J, Thomeé R (2017) Return to knee-strenuous sport after anterior cruciate ligament reconstruction: a report from a rehabilitation outcome registry of patient characteristics. Knee Surg Sports Traumatol Arthrosc 25:1364–1374

    Article  Google Scholar 

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

    Article  Google Scholar 

  40. Tejwani SG, Prentice HA, Wyatt RWB, Maletis GB (2018) Femoral tunnel drilling method: risk of reoperation and revision after anterior cruciate ligament reconstruction. Am J Sports Med 46:3378–3384

    Article  PubMed  Google Scholar 

  41. Thomas T, Robinson C, Champion D, McKell M, Pell M (1998) Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain 75:177–185

    Article  CAS  PubMed  Google Scholar 

  42. Shaarani SR, O’Hare C, Quinn A, Moyna N, Moran R, O’Byrne JM (2013) Effect of prehabilitation on the outcome of anterior cruciate ligament reconstruction. Am J Sports Med 41:2117–2127

    Article  PubMed  Google Scholar 

  43. Webster KE, Feller JA (2019) A research update on the state of play for return to sport after anterior cruciate ligament reconstruction. J Orthop Traumatol 20:10–17

    Article  PubMed  PubMed Central  Google Scholar 

  44. Webster KE, Nagelli CV, Hewett TE, Feller JA (2018) Factors associated with psychological readiness to return to sport after anterior cruciate ligament reconstruction surgery. Am J Sports Med 46:1545–1550

    Article  PubMed  PubMed Central  Google Scholar 

  45. Youm YS, Cho SD, Lee SH, Youn CH (2014) Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Am J Sports Med 42:2941–2947

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain

    Matias Ruiz-Lozano, Francisco A. Miralles-Muñoz, Marta Rubio-Morales, Rosario Martin-Grandes & Alejandro Lizaur-Utrilla

  2. Department of Traumatology and Orthopaedia, Miguel Hernandez University, 03550, San Juan de Alicante, Alicante, Spain

    Alejandro Lizaur-Utrilla

  3. Clinical Nursing Research Group, Faculty of Health Sciences, University of Alicante, 03690, San Vicente del Raspeig, Alicante, Spain

    Maria F. Vizcaya-Moreno

Authors
  1. Matias Ruiz-Lozano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francisco A. Miralles-Muñoz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marta Rubio-Morales
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rosario Martin-Grandes
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alejandro Lizaur-Utrilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria F. Vizcaya-Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by MR-L, FAM-M and MR-M. Formal data analysis was performed by RM-G, and MFV-M. The first draft of the manuscript was written by MR-L and AL-U. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alejandro Lizaur-Utrilla.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There was no funding for this study.

Ethical approval

The present study was approved by the Institutional Review Board of the Elda University Hospital (ID number: PI2014-97), and informed consent was required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ruiz-Lozano, M., Miralles-Muñoz, F.A., Rubio-Morales, M. et al. Similar outcomes and satisfaction after transtibial versus transportal femoral drilling for anterior cruciate ligament reconstruction in young adult recreational athletes. Knee Surg Sports Traumatol Arthrosc 30, 1197–1203 (2022). https://doi.org/10.1007/s00167-020-06393-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-020-06393-8

Keywords

Search

Navigation