A meta‑analysis on anterior cruciate ligament reconstruction: Is modified transtibial technique inferior to independent drilling techniques?

Abstract

This report respectively compared the standard transtibial (sTT) technique to the independent drilling (ID) techniques applied to anterior cruciate ligament (ACL) reconstruction. It also made a comparison between the clinical results of the modified transtibial (mTT) technique and of the ID techniques. Prospective studies on transtibial (TT) and ID techniques for ACL reconstruction were retrieved from several databases and a subgroup analysis was performed to compare the sTT technique with the ID techniques and the mTT with the ID techniques. Furthermore, comparison of the Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC) subjective and objective evaluations, Lysholm score and Tegner activity scale were conducted. This report included 12 clinical studies that involved 681 patients having received ACL reconstruction. The study results indicated that in comparison between the sTT and ID techniques, the ID techniques outperformed the sTT technique in the IKDC subjective score (P=0.01) and laxity (P=0.0004). However, there was no significant difference in the IKDC objective score (P=0.34), pivot-shift test (P=0.24), Lachman test (P=0.21), Lysholm score (P=0.14) and Tegner activity scale (P=0.66). The comparison between the new mTT technique and the ID techniques suggested no significant difference in the IKDC objective and subjective scores (P=0.86), laxity (P=0.38), pivot-shift test (P=0.66), Lachman test (P=0.10), Lysholm score (P=0.10) and Tegner activity scale (P=0.55). Compared to the sTT technique, the mTT and ID techniques are more suitable for ACL reconstruction because they can present better subjective feelings. Moreover, considering that the TT technique is familiar to surgeons and the mTT technique can bring favorable subjective feelings and objective clinical outcomes, the mTT technique shows greater utilization potential.

Effects of modified trans-tibial versus trans-portal technique on stress patterns around the femoral tunnel in anatomical single-bundle ACL reconstruction with different knee flexion angles using finite element analysis

“…However, several studies have demonstrated that the graft bending angle after the TP technique could be more acute than that after the TT technique, resulting in potential increase in mechanical stress around the bone tunnel orifice [ 10 – 13 , 16 , 28 , 46 ]. Since recent meta-analaysis demonstrated that the comparison between the modified TT and the TP technique demonstrated no significance difference in the clinical outcomes including anteroposterior and rotational stabilities [ 47 ], other factors rather than the kinematic stability of postoperative knee need to be elucidated to determine the optimal ACL reconstruction technique. Hence, we focused the stress patterns arising in the femoral bone, which were not well investigated before.…”

ACL Reconstruction Graft Angle and Outcomes: Transtibial vs Anteromedial Reconstruction

“…However, results of other analyses conflict with that contention, showing AM superiority with higher proportions of negative Lachman and pivot–shift tests, and better Lysholm and International Knee Documentation Committee (IKDC) scores [6, 11, 30, 50]. Other reviews offer a more mixed picture, with AM providing superior IKDC subjective scores but similar IKDC objective scores and pivot–shift test, Lachman test, Lysholm, and Tegner activity scale scores [53]. In terms of graft failure, research has shown mixed results, with some studies suggesting no correlation between AM and TT techniques and others showing higher failure with AM technique [10, 38, 44, 45, 51].…”