Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

Sukur, Erhan; Akman, Yunus Emre; Senel,; Unkar,; Topcu,; Ozturkmen,; Yusuf, Yusuf

doi:10.2174/1874325001610010481

Cited by 13 publications

(18 citation statements)

References 40 publications

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“…However, deep-knee bending is required when creating the femoral tunnel using this method, and insufficient femoral tunnel length and iatrogenic femoral chondral tear are potential complications. 36,56,64,67,82,91 The transtibial technique is the most traditional technique used to create the femoral ACL tunnel. Although, there is no need to worry about the iatrogenic problems that are potential complica-tions in the transportal technique, it is relatively demanding to reach the center of the native ACL footprint using this technique.…”

Section: Discussionmentioning

confidence: 99%

“…Although, there is no need to worry about the iatrogenic problems that are potential complica-tions in the transportal technique, it is relatively demanding to reach the center of the native ACL footprint using this technique. 35,37,72,78,79,82,87 In the outside-in technique, no restrictions exist for femoral tunnel placement. However, special devices such as a backward drill are required, and a femoral incision is needed.…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction

Iriuchishima¹,

Goto²

2020

J Knee Surg

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The purpose of this systematic review was to reveal the trend in surgical technique and tunnel targets points and placement in anatomical single-bundle anterior cruciate ligament (ACL) reconstruction. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, data collection was performed. PubMed, EMBASE, and Cochran Review were searched using the terms “anterior cruciate ligament reconstruction,” “anatomic or anatomical,” and “single bundle.” Studies were included when they reported clinical results, surgical technique, and/or tunnel placement evaluation. Laboratory studies, technical reports, case reports, and reviews were excluded from this study. From these full article reviews, graft selection, method of creating the femoral tunnel, and femoral and tibial tunnel target points and placement were evaluated. In the 79 studies included for data evaluation, the selected grafts were: bone patella tendon bone autograft (12%), and hamstring autograft (83%). The reported methods of creating the femoral tunnel were: transportal technique (54%), outside-in technique (15%), and transtibial technique (19%). In the 60 studies reporting tunnel target points, the target point was the center of the femoral footprint (60%), and the center of the anteromedial bundle footprint (22%). In the 23 studies evaluating tunnel placement, the femoral tunnel was placed in a shallow–deep direction (32.3%) and in a high–low direction (30.2%), and the tibial tunnel was placed from the anterior margin of the tibia (38.1%). The results of this systematic review revealed a trend in anatomical single-bundle ACL reconstruction favoring a hamstring tendon with a transportal technique, and a tunnel target point mainly at the center of the ACL footprint. The level of evidence stated is Systematic review of level-III studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction

Iriuchishima¹,

Goto²

2020

J Knee Surg

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“…The TT technique for femoral tunnel placement offers a less technically demanding method for femoral tunnel placement via improved visualization (knee at 90°), decreased operative time, surgeon familiarity, and lack of need for an assistant but often results in a nonanatomic femoral tunnel, which can lead to graft failures. 10 , 12 , 13 , 15 , 16 , 17 An ideal method for creation of the femoral tunnel combines the benefits of both methods and minimizes the negatives of each technique. The authors feel that the Pathfinder guide affords the ease of use of the TT technique while also providing the more anatomic placement of the AM portal technique, yet without the previously mentioned negatives associated with the AM portal technique.…”

Section: Discussionmentioning

confidence: 99%

Anterior Cruciate Ligament Tunnel Placement Using the Pathfinder Guide

Patel

Chhabra

Makovicka

et al. 2017

Arthroscopy Techniques

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Reconstruction techniques for the anterior cruciate ligament (ACL) have evolved considerably over the past 3 decades. The femoral tunnel is most commonly made via a transtibial or separate anteromedial portal approach. Benefits and drawbacks for each of these techniques exist. Improper tunnel placement is the cause of failure for ACL reconstruction 70% of the time. We present a hybrid technique for femoral tunnel placement using the Pathfinder ACL guide, which attempts to give the surgeon many of the benefits of both the transtibial and anteromedial portal techniques without the drawbacks.

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“…However, this approach can limit the accuracy of femoral tunnel placement, and failure of the reconstruction may be influenced most by inaccurate tunnel placement [2, 3]. The anteromedial portal (AMP) approach is becoming more popular as femoral tunnel placement is not limited by the tibial tunnel, resulting in easier and potentially more accurate location of the femoral tunnel in the ACL anatomical footprint [4–7]. Differences have been shown in femoral tunnel location between AMP and TT methods in previous retrospective studies [5, 8–10].…”

Section: Introductionmentioning

confidence: 99%

Comparison of 2 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction. A prospective randomized comparative study.

Geng

Gai

2018

BMC Musculoskelet Disord

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BackgroundTo evaluate the length and position of femoral tunnel,and exam whether knee stability and clinical functional outcomes are superior in AMP method.MethodsFrom August 2014 to February 2015, we prospectively recruited 104 patients undergoing anterior cruciate ligament reconstruction. They were randomized to anteromedial portal or transtibial method. All patients underwent Lysholm score, International Knee Documentation Committee score,Tegner score at pre-operative and last follow-up point as subjective assessment of clinical function. The Lachman test, the Pivot-shift test and KT-1000 were performed at the last follow-up as a evaluation of knee joint stability. We measured the length of femoral tunnel intraoperatively and at 1 week post-operatively, CT-based three-dimensional reconstruction was used to assess femoral tunnel location.ResultsThe average follow-up time of anteromedial portal group was 25.7 ± 6.8 months (range:12–36.5 months), and the average follow-up time of the transtibial group was 24.9 ± 6.0 months (range:12–37 months). There was no significant difference between the groups pre-operative Lysholm score, IKDC score and Tegner scores. Both groups showed significantly improvement in these clinical function scores at follow up for their ACL reconstruction. However, there was no significant difference in the function scores between the two groups at last follow up. However, the mean femoral tunnel length in the anteromedial portal group was significantly shorter than that in the transtibial group. And tunnel location was significantly lower and deeper with the anteromedial portal technique than with the transtibial technique.ConclusionThe use of anteromedial portal method resulted in a significantly lower and deeper placement of the femoral tunnel, and a shorter tunnel length compared to the transtibial method. However, there was no statistical difference in terms of clinical function and knee joint stability between the anteromedial portal method and the transtibial method.Trial registrationName of the registry: Chinese Clinical Trial Registry.The registration number: ChiCTR1800014874.The date of registration: 12 February, 2018.The study is retrospectively registered.

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Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

Cited by 13 publications

References 40 publications

Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction

Systematic Review of Surgical Technique and Tunnel Target Points and Placement in Anatomical Single-Bundle ACL Reconstruction

Anterior Cruciate Ligament Tunnel Placement Using the Pathfinder Guide

Comparison of 2 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction. A prospective randomized comparative study.

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