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

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, midquadriceps 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.

Validity of Single Leg Hop Test in Comparison of Lysholm Score after ACL Reconstruction through Anteromedial Portal Technique by Using Hamstring Tendon

“…Matthias Buchner, et al [20] showed the score of 8.14±2.25 with 73% very satisfied, 23% satisfied and 4% unsatisfied. Eduard Alentorn-Geli, et al [23] also resulted in high patient satisfaction with mean score of 9.1. In our study the mean VAS score for patient satisfaction is 7.6.…”

“…The surgical technique used in our study is of single bundle reconstruction using the anteromedial portal in which the femoral tunnel was made independently of the tibial tunnel placing the graft more anatomical and giving better stability and clinical results which has been proved by various studies like Christopher D. Harner et al [21], Steiner Mark et al [22], Eduard Alentorn Geli, Gonzalo Samitier et al [23] . Matthias Buchner, et al [20] showed complications like re surgery in 13% of patients and re rupture at follow up in 7% of patients.…”

Early Results of Anatomic Double Bundle Anterior Cruciate Ligament Reconstruction

“…Femoral tüne-lin transtibial teknik kullanılarak drillenmesinde femoral tünel-lerin lokalizasyonu ve oryantasyonunun ayarlanmasındaki güçlü-ğe bağlı olarak anatomik olmayan tünel yerleşimi ile sonuçlana-bilir. Transtibial anatomik olmayan tünel yerleşimi yerine aksesuar anteromedial portal kullanılarak yapılan anatomik tek tünel ÖÇBR nun ön-arka ve rotasyonel diz stabilitesini ve IKDC skorlarını iyileştirdiği bildirilmiştir [23,24]. Kondo ve ark.…”

Reply to: Comments on Alentorn-Geli et al.: Anteromedial portal (AMP) versus transtibial (TT) drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up

“…Dear Editor, We read with great interest the comments on our article entitled "Anteromedial portal (AMP) versus transtibial (TT) drilling techniques in ACL reconstruction: a blinded crosssectional study at two-to five-year follow-up" [1] by Sunil Gurpur Kini.…”