A radiological comparative study between transtibial &amp; anteromedial portal drilling of femoral tunnel in single bundle anterior cruciate ligament reconstruction: A comparison of four angles

Shetty, Sowmya; Shetty, Vikram; Ballal, Arjun; Mohanchandran, Jeetu; Hegde, Anoop

doi:10.1016/j.jajs.2015.11.011

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…Some radiographic studies have revealed that drilling the femoral tunnel through the AM arthroscopy portal rather than using a TT drilling technique resulted in a graft position more posterior and closer to a position that has been suggested as favorable on a lateral radiograph of the knee. 2,26,59,61,66,70,79,84 In the frontal plane, the bone tunnel is inclined more toward the lateral cortex of the lateral femoral condyle when drilled through the AM portal, eventually resulting in superior rotatory stabilization of the knee joint compared with TT drilling. 12 In general, it is difficult to accurately identify the tunnel location on 2dimensional images (radiograph, CT, or MRI) and impossible to accurately measure tunnel diameter (the tunnels appear as ellipses on the axial images).…”

Section: Discussionmentioning

confidence: 99%

“…The graft choice included hamstring autograft (71.8%), bone-patellar tendon-bone (BPTB) autograft (20.5%), BPTB allograft (2.6%), tibialis posterior allograft (2.6%), and Achilles tendon allograft (2.6%). Two studies (5%) did not specify which type of graft was used 1,66 (Supplemental Table S2).…”

Section: Surgical Technicalitiesmentioning

confidence: 99%

“…Those authors found that femoral tunnel widening was significantly associated with anterior joint instability when all of the patients were evaluated as a single cohort (P < .001). Regarding outcomes with respect to ACL graft placement in both the AM and the TT groups, 5 radiological studies 2,26,66,70,79 concluded that the optimal tunnel location was more often reproduced with the AM technique. This enables a more horizontal or oblique position close to the native ACL.…”

Section: Radiographic Outcomesmentioning

confidence: 99%

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Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review

Loucas

D’Ambrosi

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The drilling technique used to make a femoral tunnel is critically important for determining outcomes after anterior cruciate ligament (ACL) reconstruction. The 2 most common methods are the transtibial (TT) and anteromedial (AM) techniques. Purpose: To determine whether graft orientation and placement affect clinical outcomes by comparing clinical and radiological outcomes after single-bundle ACL reconstruction with the AM versus TT technique. Study Design: Systematic review; Level of evidence, 3. Methods: Articles in PubMed, EMBASE, the Cochrane Library, ISI Web of Science, Scopus, and MEDLINE were searched from inception until April 25, 2020, using the following Boolean operators: transtibial OR trans-tibial AND (anteromedial OR trans-portal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. Results: Of 1270 studies retrieved, 39 studies involving 11,207 patients were included. Of these studies, 14 were clinical, 13 were radiological, and 12 were mixed. Results suggested that compared with the TT technique, the AM technique led to significantly improved anteroposterior and rotational knee stability, International Knee Documentation Committee (IKDC) scores, and recovery time from surgery. A higher proportion of negative Lachman ( P = .0005) and pivot-shift test ( P = .0001) results, lower KT-1000 arthrometer maximum manual displacement ( P = .00001), higher Lysholm score ( P = .001), a higher incidence of IKDC grade A/B ( P = .05), and better visual analog scale score for satisfaction ( P = .00001) were observed with the AM technique compared with the TT technique. The AM drilling technique demonstrated a significantly shorter tunnel length ( P = .00001). Significant differences were seen between the femoral and tibial graft angles in both techniques. Low overall complication and revision rates were observed for ACL reconstruction with the AM drilling technique, similar to the TT drilling technique. Conclusion: In single-bundle ACL reconstruction, the AM drilling technique was superior to the TT drilling technique based on physical examination, scoring systems, and radiographic results. The AM portal technique provided a more reproducible anatomic graft placement compared with the TT technique.

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Section: Discussionmentioning

confidence: 99%

Section: Surgical Technicalitiesmentioning

confidence: 99%

Section: Radiographic Outcomesmentioning

confidence: 99%

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Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review

Loucas

D’Ambrosi

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…The most important advantage of the anteromedial (AM) portal technique is allowing of placement of the femoral tunnel (FT) independent of the tibial tunnel (TT) in the more horizontal position (2,4,13,20). However, there have been some infrequent reports of posterior wall breakage of the FT (12,16).…”

Section: Introductionmentioning

confidence: 99%

How the Aperture of Femoral Tunnel Affected in ACL Reconstruction Performed with AM Portal Technique?

Bombacı¹,

Çetinkaya²,

Akıncı³

et al. 2021

ACHOT

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PURPOSE OF THE STUDYThe purpose of this study was to evaluate the position of tibial tunnel (TT) and femoral tunnels (FT) performed by using the anteromedial (AM) portal technique and its effect on the aperture of FT. MATERIAL AND METHODSA total 44 patients operated for anterior cruciate ligament (ACL) rupture by AM portal technique between January 2013 and July 2015, were included in this study. They were subjected to a magnetic resonance imaging of the knee to assess the FT, dimensions of the FT aperture and TT. The location of the ACL graft within the joint was compared with the intact ACL of healthy individuals. The patients were also evaluated using Lysholm and IKDC subjective scores for functional outcome. RESULTSThe mean FT angle on both the coronal plane (42.88°±5.83°) and the sagittal plane (68.47°±9.57°) was significantly different from the intra-articular part of the hamstring autograft angles (74.93°±7.27° and 58.74°±4.88°, respectively) (p<0.0001). The mean distance of the FT aperture was 13.18 (±2.49) mm on vertical axis, 10.97 (±1.50) mm on the sagittal axis (p<0.0001). The difference between TT axis and the axis of the intra-articular part of autograft on both coronal (72.78°±4.67° and 74.93°±7.27°, respectively) and sagittal planes (60.12°±5.53° and 58.74°±4.88°, respectively) were not significant (p>0.05). DISCUSSIONIlingrowth et al. claimed that the FT were scattered in the very large distance and some of them were placed outside of anatomical range in the series included the cases performed with transtibial and transtibial independent techniques. In this series, in which we used a femoral guide to drill the FT at lateral femoral condyle at 2 or 10 o'clock position depended upon the site of operation, we obtained a consistent FT which is comparable with the intra-articular part of native ACL. Amano et al. found that the FT aperture enlargement was significant in the series when hamstring tendons were used as autograft, over a 6-month period. We also found a significant difference between the narrowest part of the FT (7.01 ± 1.05 mm) and its aperture (10.97 ± 1.50 mm in sagittal, 13.18 ± 2.49 mm in vertical direction). The enlargement was mainly in the vertical direction, due to the fact that the loads resulting from daily life are mostly on the horizontal plane. CONCLUSIONSThe direction of intra-articular part of the ACL graft in the cases operated with the AM portal technique is significantly different from the FT direction in both the coronal and sagittal planes. The enlargement of the FT aperture is larger in the vertical axis compared to the sagittal axis. Although the long-term clinical consequences of asymmetrical enlargement of the FT aperture are not known yet, to avoid this potential risk, a technique to approximate the direction of FT to the intra-articular part of the ACL without changing the FT entry site, can be used.

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Comparison of femoral tunnel length and obliquity of anatomic versus nonanatomic anterior cruciate ligament reconstruction: A meta-analysis

et al. 2020

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Theoretical considerations suggest that femoral tunnel length might cause graft mismatch, and femoral tunnel obliquity could be related to the longevity of graft in anterior cruciate ligament (ACL) reconstruction. However, controversy still exists regarding these issues in the context of the comparison of anatomic and nonanatomic ACL reconstructions. The purpose of this meta-analysis was to compare the length and obliquity of the femoral tunnel created by drilling through either anatomic or nonanatomic ACL reconstructions. Materials and method In this meta-analysis, we reviewed studies that compared femoral tunnel length and femoral tunnel obliquity in the coronal plane with the use of anatomic or nonanatomic ACL reconstruction. The major databases were reviewed for appropriate studies from the earliest available date of indexing through December 31, 2018. No restrictions were placed on the language of publication. Results Twenty-seven studies met the criteria for inclusion in this meta-analysis. The femur tunnel length of anatomic ACL reconstruction was significantly shorter compared with that of nonanatomic ACL reconstruction by 8.66 mm (95% CI: 7.10-10.22 mm; P<0.001), while the femur tunnel obliquity in the coronal plane of anatomic ACL reconstruction was significantly more oblique versus that of nonanatomic ACL reconstruction by 15.29˚(95% CI: 8.07˚-22.52˚; P<0.001). Similar results in terms of femoral tunnel length were found for the subgroup with cadaveric (7.15 mm; 95% CI: 2.69-11.61 mm; P = 0.002) and noncadaveric (8.96 mm; 95%

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A radiological comparative study between transtibial & anteromedial portal drilling of femoral tunnel in single bundle anterior cruciate ligament reconstruction: A comparison of four angles

Cited by 3 publications

References 22 publications

Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review

Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review

How the Aperture of Femoral Tunnel Affected in ACL Reconstruction Performed with AM Portal Technique?

Comparison of femoral tunnel length and obliquity of anatomic versus nonanatomic anterior cruciate ligament reconstruction: A meta-analysis

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