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Transtibial Technique

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Controversies in the Technical Aspects of ACL Reconstruction

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Abstract

In this chapter, we first review the history of biomechanical and clinical evaluation studies of the transtibial (TT) technique for single-bundle (SB) and double-bundle (DB) ACL reconstructions, specifically in comparison with the anteromedial portal (AMP) technique. Second, we explain about necessity of reevaluation on the utility of the modern TT techniques and that a fundamental problem exists in reevaluating the TT technique in comparison with the AMP techniques. Third, we summarize the essence of the TT technique and the theory of the anatomic femoral tunnel creation and introduce practical TT techniques for anatomic SB and DB reconstructions, respectively. The TT technique does not mean a simple technique in which a surgeon creates a femoral tunnel through a tibial tunnel created independently to the femoral tunnel. The TT technique is a technique to create the anatomical femoral tunnel through a tibial tunnel using two types of special procedures performed by a surgeon. First, a surgeon must create a tibial tunnel that goes to the most appropriate point to create an anatomical femoral tunnel. Second, the surgeon should apply an adequate amount of distraction, varus, and rotatory forces to the tibia to utilize the physiological knee laxity in the femoral tunnel creation through such a tibial tunnel. This chapter have explained that the anatomic tunnel creation can be successfully performed with the modern TT techniques in both SB and DB reconstructions, although there are some controversies concerning the anatomic femoral point on the femoral condyle.

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Author information

Authors and Affiliations

  1. Department of Sports Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Kazunori Yasuda

  2. Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea

    Myung Chul Lee

  3. Middlemore Hospital, Auckland, New Zealand

    Mark Clatworthy

Authors
  1. Kazunori Yasuda
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  2. Myung Chul Lee
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  3. Mark Clatworthy
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Corresponding author

Correspondence to Kazunori Yasuda .

Editor information

Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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Yasuda, K., Lee, M.C., Clatworthy, M. (2017). Transtibial Technique. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_22

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  • DOI: https://doi.org/10.1007/978-3-662-52742-9_22

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-52740-5

  • Online ISBN: 978-3-662-52742-9

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