Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials

Abstract

BackgroundThe aim of this study was to compare the clinical outcome and postoperative complication between single-bundle anterior cruciate ligament (ACL) reconstruction with an anteromedial (AM) technique and a transtibial (TT) technique.MethodsThe study includes clinical randomized controlled trials comparing the clinical outcomes of ACL reconstruction using the autologous hamstring tendon with an AM method and a TT method published up to September 2017 were retrieved from PubMed, Cochrane Library, and Embase databases. Relevant data were extracted and the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality. Stata/SE 12.0 was used to perform a meta-analysis of the clinical outcome.ResultsFive RCTs were included, with a total of 479 patients: 239 patients and 240 patients in the AM group and the TT group, respectively. Assessing postoperative stability, better results were found in the AM group for the negative rate of the Lachman test (P < 0.05), the negative rate of the pivot-shift test (P < 0.05) and the side-to-side difference (P < 0.05). Assessing postoperative functional outcome, the AM group yielded superior results in proportion with International Knee Documentation Committee (IKDC) grade A (P < 0.05) and the Lysholm scores (P < 0.05) but had a comparable IKDC score (P > 0.05). In terms of postoperative complication, no significant difference was found between the AM group and the TT group (P > 0.05).ConclusionsThe outcome of single-bundle ACL reconstruction with the AM technique is better than that with the TT technique in terms of postoperative stability and functional recovery of the knee.

Greater magnitude tibiofemoral contact forces are associated with reduced prevalence of osteochondral pathologies 2–3 years following anterior cruciate ligament reconstruction

“…Medial resection + lateral repair 1 3Medial repair + untreated medial tear 4 (11) Lateral repair + untreated lateral tear 3 (8) Total (n) 38…”

Untitled

“…Alerton et al reported better short term results with Trans-portal technique but no difference at mid and long term follow-up [20] . A metaanalysis of 5 RCTs by Chen et al concluded that in terms of postoperative stability and functional recovery of the knee the outcome of single-bundle ACL reconstruction with the AM technique is better than that with the TT technique [21] However at present there isn't enough clinical evidence to support one technique over the other. Trans-tibial technique is an easily reproducible, safe and technically less demanding and time tested.…”

Single-Bundle Anterior Cruciate Ligament Reconstruction: Meta-analysis About Anteromedial Versus the Transtibial Technique

“…Since 2010 there are many research [9] have reported the comparison between anteromedial and the transtibial and some of them show that the AM technique may have a superior outcome, last year two meta-analysis [10,11](up to 2015) get agreement on the results that based on the physical examination and scoring system results the AM technique is superior to the TT technique. But the RCT and the retrospective results in recent year also lead a idea that the two technique have no clinical differences.…”