Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study

Lanzetti, Riccardo Maria; Lupariello, Domenico; Carli, Angelo De; Monaco, Edoardo; Guzzini, Matteo; Fabbri, Mattia; Vadalà, Antonio; Ferretti, Andrea

doi:10.1007/s00590-017-1950-8

Cited by 9 publications

(15 citation statements)

References 30 publications

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“…An analysis on the IKDC subjective score as a continuous variable was performed (14,19–21). There were 257 patients in four studies included in the comparison between the sTT and the ID techniques.…”

Section: Resultsmentioning

confidence: 99%

“…The difference in the anterior displacement of the tibia between bilateral knee joints was employed to assess the difference in anterior displacement of the tibia between the operated and the intact knees (14,19–21,24,25). In four studies, the KT-1000 knee arthrometer was adopted while the KT-2000 knee arthrometer was applied to another two studies.…”

Section: Resultsmentioning

confidence: 99%

“…An analysis on the Lachman test results as dichotomous variables was conducted (14,16,19,22) and the OR value was defined as ‘(number of patients with positive test results)/(number of patients with negative test results)’. There were 159 patients in four studies included in the comparison between the sTT and the ID techniques.…”

Section: Resultsmentioning

confidence: 99%

“…The Lysholm knee score was analyzed as a continuous variable (14,16,19,14) in eight articles where a total number of 501 patients were included in the comparison between the sTT and the ID techniques. The results indicated no statistically significant differences in Lysholm knee score between the sTT and the ID group [SMD=−0.19, 95% CI (−0.44, 0.06), P=0.14].…”

Section: Resultsmentioning

confidence: 99%

“…P<0.05 suggested a significant difference in analytical results. In some studies (14–17), continuous variables were expressed by medians and numerical ranges. The method put forward by Hozo et al (18) in 2005 was employed to estimate means and variances; some used means and P-values to report continuous variables.…”

Section: Data Collection Methodsmentioning

confidence: 99%

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

2018

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Data Collection Methodsmentioning

confidence: 99%

See 3 more Smart Citations

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

2018

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A comparative analysis of the efficacy of anterior cruciate ligament reconstruction with autologous ligament grafting at different time points

Gao

et al. 2020

Clinical Laboratory Analysis

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Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis

Jong

Çelik

Kim

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose In anterior cruciate ligament (ACL) reconstruction, there is concern regarding the potential risk of femoral tunnel widening in the anteromedial portal (AMP) technique due to the acute graft‐bending angle at the aperture and the more elliptical aperture shape of the femoral tunnel compared to the transtibial (TT) techniques. Therefore, the aim of the current systematic review and meta‐analysis was to compare the femoral tunnel widening between the AMP and TT techniques in patients who underwent ACL reconstruction. Methods It should be included the studies that reported on femoral tunnel widening in patients who underwent single‐bundle ACL reconstruction, using soft‐tissue tendon graft, with AMP and/or TT techniques. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACL reconstruction. Results Twenty‐one studies were finally included in this meta‐analysis. The pooled changes of absolute millimeters of tunnel widening from the immediate postoperative status to the last follow‐up did not differ significantly between the AMP and TT techniques at both the aperture [3.31 mm, 95% confidence interval (CI) 1.7–5.0. mm versus 2.9 mm, 95% CI 2.4–3.4 mm, P = n.s.] and the midportion (3.5 mm, 95% CI 0.8–6.3 mm versus 3.0 mm, 95% CI 2.2–3.9 mm, P = n.s.) of the femoral tunnel. No significant difference was observed between the two techniques in the relative percentage of femoral tunnel widening (AMP; 28.8%, 95% CI 14.8–42.9% vs. TT; 29.7%, 95% CI 15.6–43.7%, P = n.s.). Conclusion No significant difference in femoral tunnel widening was observed between the AMP and TT techniques, both in absolute millimeter and relative percentage, in patients who underwent single‐bundle ACL reconstruction. This finding could alleviate the potential concerns associated with femoral tunnels being wider for the AMP than for the TT technique. Level of evidence III.

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Can the outside-in half-tunnel technique reduce femoral tunnel widening in anterior cruciate ligament reconstruction? A CT study

Abstract: In ACLR with a suspension system, the outside-in technique leads to less enlargement of the femoral tunnel lower than the transtibial technique.

Cited by 9 publications

References 30 publications

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

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

A comparative analysis of the efficacy of anterior cruciate ligament reconstruction with autologous ligament grafting at different time points

Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis

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