Comparison of clinical results of anteromedial and transtibial femoral tunnel drilling in ACL reconstruction

Metso, Leena; Nyrhinen, Kirsi-Maaria; Bister, Ville; Sandelin, Jerker; Harilainen, Arsi

doi:10.1186/s12891-020-03351-w

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…Recent studies with larger sample sizes and long-term follow-ups (>2 years) showed higher postoperative IKDC scores in AMP patients. 28,34,63 Thus, we believe that as the sample size increases with future studies, the IKDC score will be significantly higher in AMP patients than TT patients, as is the case with the Lysholm score. This meta-analysis showed that the AMP technique for ACLR may be more likely to produce better knee stability and superior Lysholm scores, but the TT technique can produce similar IKDC scores.…”

Section: Discussionmentioning

confidence: 92%

Transtibial Versus Anteromedial Portal Technique for Femoral Tunnel Drilling in Primary Single-Bundle Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Level 1 and 2 Evidence of Clinical, Revision, and Radiological Outcomes

Mao

Zhang

et al. 2021

Am J Sports Med

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Background: Although numerous clinical studies have compared transtibial (TT) and anteromedial portal (AMP) drilling of femoral tunnels during anterior cruciate ligament reconstruction (ACLR), there is no high-quality, evidence-based consensus regarding which technique affords the best outcome. Hypothesis: There would be no difference between the TT and AMP techniques in terms of knee stability, patient-reported outcomes, incidence of revision, and radiological results. Study Design: Meta-analysis; Level of evidence, 2. Methods: The PubMed and EMBASE databases were searched from inception to February 1, 2021. Level 1 and 2 clinical trials that compared TT and AM techniques were included. Data were meta-analyzed for the outcome measures of knee stability, patient-reported functional outcomes, incidence of revision, and radiological results. Dichotomous variables were presented as odds ratios (ORs), and continuous variables were presented as mean differences (MDs) and standard mean differences (SMDs). Results: The meta-analysis included 18 clinical studies, level of evidence 1 or 2, that involved 53,888 patients. Pooled data showed that the AMP group had a lower side-to-side difference (SMD, 0.22; 95% CI, 0.06 to 0.39; P = .009), a lower incidence of pivot-shift phenomenon (OR, 3.69; 95% CI, 1.26 to 10.79; P = .02), and a higher postoperative Lysholm score (SMD, −0.26; 95% CI, −0.44 to −0.08; P = .005) than the TT group. However, no statistically significant differences were seen in other outcomes, including subjective International Knee Documentation Committee scores (SMD, –0.11; 95% CI, –0.30 to 0.09; P = .30) or grades (OR, 0.93; 95% CI, 0.35 to 2.49; P = .89), postoperative activity level (MD, –0.14; 95% CI, –0.42 to 0.15; P = .35), and incidence of revision ACLR (OR, 1.04; 95% CI, 0.93 to 1.16; P = .45). The TT technique was more likely to create longer (SMD, 1.05; 95% CI, 0.05 to 2.06; P = .04) and more oblique (SMD, 0.81; 95% CI, 0.51 to 1.11; P < .001) femoral tunnels than the AMP technique, and a higher height ratio of the aperture position was detected with the TT technique (SMD, −3.51; 95% CI, −5.54 to −1.49; P < .001). Conclusion: The AMP technique for ACLR may be more likely to produce better knee stability and improved clinical outcomes than the TT technique, but no difference was found in the incidence of revision between the 2 groups.

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Section: Discussionmentioning

confidence: 92%

Transtibial Versus Anteromedial Portal Technique for Femoral Tunnel Drilling in Primary Single-Bundle Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Level 1 and 2 Evidence of Clinical, Revision, and Radiological Outcomes

Mao

Zhang

et al. 2021

Am J Sports Med

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“…In was no significant difference between the anteromedial and transtibial techniques in terms of maintaining knee stability (34). Jinzhong Zhao stated that an anatomical femoral tunnel will be created when the tibial tunnel is opened in accordance with the sagittal plane and tibial axis during the creation of the tibial tunnel (35,36).…”

Section: Discussionmentioning

confidence: 99%

A comparison of clinical results of transtibial and transportal anatomical techniques in the arthroscopic reconstruction of anterior cruciate ligament

Baymurat¹,

Tahta²,

Uysal³

2022

acmr

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Background:The present study aims to compare the clinical outcomes of patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction with Transtibial (TT) and Transportal Anatomical (TA) techniques with the diagnosis of ACL rupture.Methods: A total of 56 patients who underwent arthroscopic ACL repair in the Orthopedics and Traumatology Clinic of Menemen State Hospital between 2015 and 2020 were included in the study. The mean age of the patients was 25 years, and follow-up period was 31 months. Of the patients, 53 were male, 3 were female, and 43 had ACL ruptures in the right knee and 13 in the left knee. ACL reconstruction was performed using the TT technique in 29 patients and the TA technique in 27 patients. Patients were evaluated using the Lysholm Assessment score, the Modified Cincinnati Rating System Questionnaire, the Tegner Activity Level Scale, and the International Knee Documentation Committee scoring.Results: There was a significant difference in pre and postoperative controls (p<0.05) and while normal and near-normal results were obtained with the TT (89%) and TA (87%) techniques, there was no statistically significant difference between the two techniques when the postoperative data were compared (p>0.05). Conclusions:In this study, there was no significant difference between the two techniques in terms of clinical outcome and patient satisfaction. Although there are studies in the literature showing that the TA technique is superior in terms of knee stability, good results are obtained with both techniques.

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“…This is technically difficult even for an experienced arthroscopy surgeon. [16] Use of Hertel grid requires a C-arm with a special software of grid. This also increases the surgical time as well as brings large unsterile C-arm into the surgical field which increases the risk of infection.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of transportal femoral aimer in placement of femoral tunnel during arthroscopic anterior cruciate ligament reconstruction: An observational study

Thapa¹,

Joshi

Singh

et al. 2021

JASSM

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Objectives: Incorrect placement of the femoral tunnel can result in failure of anterior cruciate ligament reconstruction. Several techniques have been described in literature to make accurate femoral tunnel. Although eyeballing and femoral offset aimer are commonly used, they are considered to be less accurate if used in isolation. To the best of our knowledge, no study has evaluated the use of combination of eyeballing and offset aimer to make the femoral tunnel. This study aims to evaluate the position of femoral tunnel made by combination of eyeballing and femoral offset aiming device. Materials and Methods: Post-operative radiographs of 50 patients were assessed. True anteroposterior (AP) and lateral view radiographs were used to evaluate the placement of the femoral tunnel using standard methods. The outcome was assessed and compared with the standard location of femoral tunnel as described by Harner et al. and Aglietti et al. Ease of making femoral tunnel and posterior blowout were recorded. Data analysis was performed using Statistical Package for the Social Sciences version 25 statistical analysis software. Results: In the coronal plane (AP view), the mean position of the femoral tunnel from the lateral cortex was at 35.09% ± 3.9% point. In AP plane (lateral view), the mean position of the femoral tunnel was at 80.01% ± 8.02% posteriorly along the Blumensaat’s line. None of the cases had posterior blowout and the technique was said to be easy. Conclusion: Eyeballing supplemented with transportal femoral offset aimer is an easy and accurate method of placing femoral tunnel and avoids posterior wall blowout.

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Comparison of clinical results of anteromedial and transtibial femoral tunnel drilling in ACL reconstruction

Cited by 7 publications

References 18 publications

Transtibial Versus Anteromedial Portal Technique for Femoral Tunnel Drilling in Primary Single-Bundle Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Level 1 and 2 Evidence of Clinical, Revision, and Radiological Outcomes

Transtibial Versus Anteromedial Portal Technique for Femoral Tunnel Drilling in Primary Single-Bundle Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Level 1 and 2 Evidence of Clinical, Revision, and Radiological Outcomes

A comparison of clinical results of transtibial and transportal anatomical techniques in the arthroscopic reconstruction of anterior cruciate ligament

Accuracy of transportal femoral aimer in placement of femoral tunnel during arthroscopic anterior cruciate ligament reconstruction: An observational study

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