ACL reconstruction: comparison between transtibial and anteromedial portal techniques

Abstract

II.

Short-Term Study of the Outcome of a New Instrument for All-Inside Double-Bundle Anterior Cruciate Ligament Reconstruction

“…33,34 A number of researchers have suggested that anteromedial approaches or outside-in approaches (or both) can yield tunnels in more anatomic positions than transtibial approaches. [35][36][37][38][39][40][41][42] In an anatomic study of ACL attachment locations using 20 human cadaveric knees, Zantop et al 25 reported that the center of the femoral AM bundle was located along the Blumensaat line at a distance of 18.5% of the sagittal diameter of the femur and at 22.3% of the height measured perpendicular to the Blumensaat line. However, other studies reported these respective parameters with considerable variability, as follows: 26.4% and 25.3% in a radiographic study of 7 cadaveric specimens, 30 21% and 24% in an anatomic study of 22 cadaveric knees with intact ACLs, 43 21.7% and 33.2% in a 3D CT study of 8 cadaveric knees, 31 and 27.7% and 16.3% in a study of 71 patients who underwent ACL reconstruction.…”

Femoral tunnel drilling in anterior cruciate ligament reconstruction: Anteromedial or transtibial portal? Current review

“…Therefore, they advocated that evaluation of the bone tunnel is more accurately done using computed tomography (CT) rather than plain radiographs. Silva et al 11 used the CT in their study to assess the tibial and femoral tunnels. They found that the AM portal technique places the femoral and tibial tunnels more centrally in the ACL footprint when compared with the TT technique.…”

Normal sagittal of the anterior cruciate ligament can be reproduced using accessory anteromedial portal technique: a magnetic resonance imaging study

“…Thus, technical modifications to the transtibial technique have been described in an effort to improve femoral tunnel obliquity and restoration of the native femoral ACL foot print [14,24]. However, there are concerns about the ability to obtain the anatomical femoral ACL foot print with a transtibial technique [7,13,16,18,23,39,43,46].…”