Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: A cadaveric study

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

“…Several authors have discussed the use of the TT versus the AMP techniques for ACL reconstruction [6,8,10,16,21,25,27,36,41], but it remains unclear which one provides better results. To our knowledge, this is the first study "in vivo" comparing clinical and functional outcomes with the use of the TT or the AMP method for drilling the femoral tunnel in the SB autologous BPTB ACL reconstruction.…”

“…The advantages that can therefore be attributed to the AMP technique are: (1) the femoral and tibial tunnels are placed independently of each other [8,10,21,25]; (2) the femoral tunnel can be drilled with knee inhyperflexion reducing the risk of posterior wall blow out [6,10]; (3) the femoral tunnel is placed more anatomically on the ACL femoral insertion site [8,10,16,21,25]; (4) the AMP technique allows for easy augmentation by preserving the remaining ACL fibres [10]; (5) the easy parallel placement of the interference screw to the bone plug with no lateral incisions [36]; (6) the tunnel placement is independent of graft type or tunnel guides [10]; and (7) it is flexible enough so that SB, double-bundle, and revision procedures may be easily performed [36]. On the other hand, several limitations do exist when using the AMP technique: (1) the femoral tunnel needs to be created with 110-120º of knee flexion to avoid injury to the posterolateral structures and posterior "blow-out"; (2) visualisation is challenging when a leg holder is used [50]; (3) several graft fixation techniques require guide instruments designed for TT insertion that may not be appropriate for the AMP technique.…”

“…Moreover, it remains unclear whether the theoretical advantages of the double-bundle reconstruction compensates for the higher complexity of this surgical procedure [39]. The use of the anteromedial portal (AMP) for drilling the femoral tunnel in the SB technique was suggested as a method to place the graft in an anatomical position and improve rotational stability, without increased complexity [3,8,10,16,25,35,46,49]. With the TT technique, the position of the femoral tunnel is dictated by the tibial tunnel, whereas the AMP technique provides the surgeon with a greater freedom to place the graft in the anatomical position [8,25].…”

Functional outcome of arthroscopic anterior cruciate ligament reconstruction with double mini incision bone patellar tendon bone graft

“…All patients underwent "anatomical" single bundle Anterior Cruciate Ligament reconstruction using BPTB graft, these included visualization of the native Anterior Cruciate Ligament, insertion sites, placing the tunnels in the footprint, knee flexion angle during femoraltunnel drilling, use of an anteromedial portal for femoral tunnel. Gavriilidis et al 2008 in their cadaveric study found that drilling through anteromedial portal found to have accurate anatomic femoral positioning of the Anterior Cruciate Ligament attachment when compared with transtibial technique [2] . Single Bundle Anterior Cruciate Ligament graft placed at the centre of the native Anterior Cruciate Ligament attachment sites is more effective at controlling anterior tibial translation and the pivot shift phenomena, and more closely reproduces normal knee kinematics, whereas in isometric non-anatomical tunnel placement resulted in the combination of a posterior tibial tunnel position and a high, deep femoral tunnel position often produced a vertical Anterior Cruciate Ligament graft .Biomechanical studies have demonstrated that a vertical anterior Cruciate Ligament graft may resist anterior tibial translation, but often fails to resist the combined motions of anterior tibial translation and internal tibial rotation which occur during the pivot-shift phenomenon.…”

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

“…Recent studies found that the TT technique results in graft placement in a more vertical position and the anteromedial (AM) technique where the femoral tunnel is drilled through an arthroscopic portal with the knee in maximum flexion allows the surgeon more flexibility to place the graft in an oblique position. [8,9] Current thinking suggests that reconstructing the ACL with an anatomically placed graft has the potential to maximize outcomes. Some studies have demonstrated superior outcomes and improved rotational stability with double-bundle reconstruction compared with single-bundle reconstructions.…”