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A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up

Archives of Orthopaedic and Trauma Surgery volume 134, pages 963–969 (2014)Cite this article

Abstract

Introduction

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.

Results

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).

Conclusions

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.

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References

  1. Musahl V, Plakseychuk A, Van Scyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-recostructed knee. Am J Sports Med 33:712–718

    PubMed  Article  Google Scholar 

  2. Streich NA, Reichenbacher S, Barié A, Buchner M, Schmitt H (2013) Long-term outcome of anterior cruciate ligament reconstruction with an autologous four-strand semitendinosus tendon autograft. Int Orthop 37:279–284

    PubMed Central  PubMed  Article  Google Scholar 

  3. Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH (2012) Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc 20(11):2200–2207

    PubMed Central  PubMed  Article  Google Scholar 

  4. Inderhaug E, Strand T, Fischer-Bredenbeck C, Solheim E (2013) Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femoral drilling. Knee Surg Sports Traumatol Arthrosc 21(9):2004–2010

    PubMed  Article  Google Scholar 

  5. Papannagari R, Gill PJ, Defrate LE, Moses JM, Petruska AJ, Li G (2006) In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation. Am J Sports Med 34:2006–2012

    PubMed  Article  Google Scholar 

  6. Wang H, Fleischli JE, Zheng NN (2013) Transtibial versus anteromedial portal technique in single-bundle anterior cruciate ligament reconstruction: outcomes of knee joint kinematics during walking. Am J Sports Med 41:1847–1856

    PubMed  Article  Google Scholar 

  7. Marchant BG, Noyes FR, Barber-Westin SD, Fleckenstein C (2010) Prevalence of nonanatomical graft placement in a series of failed anterior cruciate ligament reconstructions. Am J Sports Med 38:1987–1996

    PubMed  Article  Google Scholar 

  8. Crawford SN, Waterman BR, Lubowitz JH (2013) Long term failure of anterior cruciate ligament reconstruction. Arthroscopy 29:1566–1571

    PubMed  Article  Google Scholar 

  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):1904–1911

  10. Noh JH, Roh YH, Yang BG, Yi SR, Lee SY (2013) Femoral tunnel position on conventional magnetic resonance imaging after anterior cruciate ligament reconstruction in young men: transtibial technique versus anteromedial portal technique. Arthroscopy 29:882–890

    PubMed  Article  Google 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 92:1427–1431

    PubMed Central  PubMed  Article  Google Scholar 

  12. Bedi A, Maak T, Musahl V, Citak M, O’Loughlin PF, Choi D, Pearle AD (2011) Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: is the tibial tunnel position most important? Am J Sports Med 39:366–373

    PubMed  Article  Google Scholar 

  13. Steiner ME, Battaglia TC, Heming JF, Rand JD, Festa A, Baria M (2009) Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 37:1912–1919

    PubMed  Article  Google Scholar 

  14. Takahashi M, Doi M, Abe M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34:787–792

    PubMed  Article  Google Scholar 

  15. Franceschi F, Papalia R, Rizzello G, Del Buono A, Maffulli N, Denaro V (2013) Anteromedial portal versus transtibial drilling techniques in anterior cruciate ligament reconstruction: any clinical relevance? A retrospective comparative study. Arthroscopy 29(8):1330–1337

    PubMed  Article  Google Scholar 

  16. Kim MK, Lee BC, Park JH (2011) Anatomic single bundle anterior cruciate ligament reconstruction by the two anteromedial portal method: the comparison of transportal and transtibial techniques. Knee Surg Relat Res 23:213–219

    PubMed Central  PubMed  Article  Google Scholar 

  17. Morgan CD, Kalman VR, Grawl DM (1995) Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 11:275–288

    CAS  PubMed  Article  Google Scholar 

  18. Cohen SB, Fu FH (2007) Three-portal technique for anterior cruciate ligament reconstruction: use of a central medial portal. Arthroscopy 23(3):325 (e1–5)

    PubMed  Article  Google Scholar 

  19. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234

    CAS  PubMed  Article  Google Scholar 

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

    PubMed  Google Scholar 

  21. Hefti F, Müller W (1993) Current state of evaluation of knee ligament lesions. The new IKDC knee evaluation form. Orthopade 22(6):351–362

    CAS  PubMed  Google Scholar 

  22. Fitzgerald GK, Axe MJ, Snyder-Mackler L (2000) A decision-making scheme for returning patients to highlevel activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 8(2):76–82

    CAS  PubMed  Article  Google Scholar 

  23. Noyes FR, Barber SD, Mangine RE (1991) Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med 19(5):513–518

    CAS  PubMed  Article  Google Scholar 

  24. lllingworth KD, Hensler D, Working ZM, Macalena JA, Tashman S, Fu FH (2011) A simple evaluation of anterior cruciate ligament femoral tunnel position: the inclination angle and femoral tunnel angle. Am J Sports Med 39:2611–2618

    Article  Google Scholar 

  25. Alentron-Geli E, Samitier G, Alvarez P, 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  Google Scholar 

  26. Koutras G, Papadopoulos P, Terzidis IP, Gigis I, Pappas E (2013) Short term functional and clinical outcomes after ACL reconstruction with hamstring autograft: transtibial versus anteromedial portal technique. Knee Sports Traumatol Arthrosc 21:1904–1909

    Article  Google Scholar 

  27. Johnson DL, Swenson TM, Irrgang JJ, Fu FH, Harner CD (1996) Revision anterior cruciate ligament surgery: experience from Pittsburgh. Clin Orthop Relat Res 325:100–109

    PubMed  Article  Google 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 28:124–130

    Google 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 23:731–735

    PubMed  Article  Google Scholar 

  30. Silva A, Sampaio R, Pinto E (2012) ACL reconstruction: comparison between transtibial and anteromedial portal techniques. Knee Surg Sports Traumatol Arthrosc 20:896–903

    PubMed  Article  Google 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 20:896–903

    Article  Google Scholar 

  32. 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(11):2693–2702

    PubMed  Article  Google Scholar 

  33. Duffee A, Magnussen RA, Pedroza AD, Flanigan DC, Kaeding CC, MOON Group (2013) Transtibial ACL femoral tunnel preparation increases odds of repeat ipsilateral knee surgery. J Bone Joint Surg Am 20(95):2035–2042

    Article  Google Scholar 

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Acknowledgments

Authors thanks to Dr. Ebubekir Şenates for his contribution to this study.

Conflict of interest

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Affiliations

  1. Department of Orthopaedics and Traumatology, Dicle University Medical Faculty, 21218, Diyarbakır, Turkey

    İbrahim Azboy, Abdullah Demirtaş, Mehmet Gem, Seymuz Kıran, Celil Alemdar & Mehmet Bulut

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  1. İbrahim Azboy
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  2. Abdullah Demirtaş
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  3. Mehmet Gem
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Correspondence to İbrahim Azboy.

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Azboy, İ., Demirtaş, A., Gem, M. et al. 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 (2014). https://doi.org/10.1007/s00402-014-1996-6

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  • DOI: https://doi.org/10.1007/s00402-014-1996-6

Keywords

  • Anatomical reconstruction
  • Anterior cruciate ligament
  • Anteromedial portal
  • Transtibial technique
  • Single bundle