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Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up

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Abstract

Drilling of the femoral tunnel with the transtibial (TT) technique is widely used in bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction. Recent studies suggest higher knee stability with the use of the anteromedial portal (AMP). The purpose of this study was to compare functional and clinical outcomes of BPTB ACL reconstruction using the TT or the AMP technique for drilling the femoral tunnel. All ACL reconstructions between January 2003 and April 2006 were approached for eligibility. Forty-seven patients met inclusion criteria (21 TT group and 26 AMP group). Blinded assessments of IKDC score, knee stability and range of motion, one-leg hop test, mid-quadriceps circumference, VAS for satisfaction with surgery, Lysholm and Tegner scores, and SF-12 questionnaire were obtained for both groups. Data on preoperative and postoperative surgical timing were retrospectively reviewed through the charts. The AMP group demonstrated a significantly lower recovery time from surgery to walking without crutches (p < 0.01), to return to normal life (p < 0.03), to return jogging (p < 0.03), to return training (p < 0.03), and to return to play (p < 0.03). Knee stability values measured with KT-1000, Lachman test, pivot-shift sign, and objective IKDC score assessments were significantly better for the AMP compared to TT group (p < 0.002, p < 0.03, p < 0.02, p < 0.015, respectively). No differences were found for VAS for satisfaction with surgery, Lysholm, Tegner, and SF-12 between both groups. The use of the AMP technique significantly improved the anterior-posterior and rotational knee stability, IKDC scores, and recovery time from surgery compared to the TT technique.

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Acknowledgements

This study was made possible by Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña. We also thank Marta Pulido, MD for the contributions in the edition of the manuscript and editorial assistance, and Sergi Mojal, PhD for statistical review.

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Authors and Affiliations

  1. Artroscopia García-Cugat, Hospital Quirón, Barcelona, Spain

    Eduard Alentorn-Geli, Pedro Álvarez & Ramón Cugat

  2. Hospital 9 de Octubre, Valencia, Spain

    Gonzalo Samitier

  3. Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain

    Pedro Álvarez, Gilbert Steinbacher & Ramón Cugat

  4. Department of Orthopaedics, Hospital Quirón, Plaza Alfonso Comín 5–7, 08023, Barcelona, Spain

    Ramón Cugat

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  1. Eduard Alentorn-Geli
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  2. Gonzalo Samitier
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  3. Pedro Álvarez
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  4. Gilbert Steinbacher
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  5. Ramón Cugat
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Correspondence to Ramón Cugat.

Additional information

Level of evidence: Level III (cross-sectional comparative study).

Eduard Alentorn-Geli and Gonzalo Samitier contributed equally to this work.

No conflict of interest is declared.

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Alentorn-Geli, E., Samitier, G., Álvarez, P. et al. Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up. International Orthopaedics (SICOT) 34, 747–754 (2010). https://doi.org/10.1007/s00264-010-1000-1

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