Comparative Evaluation of the Results of Three Techniques in the Reconstruction of the Anterior Cruciate Ligament, with a Minimum Follow-up of Two Years

Overview

Journal Rev Bras Ortop

Specialty Orthopedics

Date 2017 Jul 14

PMID 28702391

Citations 3

Authors

Ricardo de Paula Leite Cury

Jan Willem Cerf Sprey

Andre Luiz Lima Bragatto

Marcelo Valentim Mansano

Herman Fabian Moscovici

Luiz Gabriel Betoni Guglielmetti

Affiliations

Soon will be listed here.

Abstract

Objective: To compare the clinical results of the reconstruction of the anterior cruciate ligament by transtibial, transportal, and outside-in techniques.

Methods: This was a retrospective study on 90 patients (ACL reconstruction with autologous flexor tendons) operated between August 2009 and June 2012, by the medial transportal (30), transtibial (30), and "outside-in" (30) techniques. The following parameters were assessed: objective and subjective IKDC, Lysholm, KT1000, Lachman test, Pivot-Shift and anterior drawer test.

Results: On physical examination, the Lachman test and Pivot-Shift indicated a slight superiority of the outside-in technique, but without statistical significance ( = 0.132 and = 0.186 respectively). The anterior drawer, KT1000, subjective IKDC, Lysholm, and objective IKDC tests showed similar results in the groups studied. A higher number of complications were observed in the medial transportal technique ( = 0.033).

Conclusion: There were no statistically significant differences in the clinical results of patients undergoing reconstruction of the anterior cruciate ligament by transtibial, medial transportal, and outside-in techniques.

Citing Articles

POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: ARE THE RESULTS SIMILAR TO ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION?.

Mestriner M, Hirosse F, Rabelo N, Netto A, Oliveira V, Cury R Acta Ortop Bras. 2023; 31(2):e260740.

PMID: 37151723 PMC: 10158965. DOI: 10.1590/1413-785220233102e260740.

Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis.

Fernandes T, Moreira H, Andrade R, Sasaki S, Bernardo W, Pedrinelli A Orthop J Sports Med. 2021; 9(6):23259671211013327.

PMID: 34262978 PMC: 8243110. DOI: 10.1177/23259671211013327.

Comparison of Clinical Outcomes between Anteromedial and Transtibial Techniques of Single-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis.

Li R, Li T, Zhang Q, Fu W, Li J J Sports Sci Med. 2021; 20(2):237-249.

PMID: 34211316 PMC: 8219276. DOI: 10.52082/jssm.2021.237.

References

Rahr-Wagner L, Thillemann T, Pedersen A, Lind M . Increased risk of revision after anteromedial compared with transtibial drilling of the femoral tunnel during primary anterior cruciate ligament reconstruction: results from the Danish Knee Ligament Reconstruction Register. Arthroscopy. 2013; 29(1):98-105. DOI: 10.1016/j.arthro.2012.09.009. View

Duffee A, Magnussen R, Pedroza A, Flanigan D, Kaeding C . Transtibial ACL femoral tunnel preparation increases odds of repeat ipsilateral knee surgery. J Bone Joint Surg Am. 2013; 95(22):2035-42. PMC: 3821156. DOI: 10.2106/JBJS.M.00187. View

Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen A . Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy. 2010; 27(3):380-90. DOI: 10.1016/j.arthro.2010.07.018. View

Steiner M, Battaglia T, Heming J, Rand J, Festa A, Baria M . Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med. 2009; 37(10):1912-9. DOI: 10.1177/0363546509340407. View

Mulcahey M, David T, Epstein D, Alaia M, Montgomery K . Transtibial versus anteromedial portal anterior cruciate ligament reconstruction using soft-tissue graft and expandable fixation. Arthroscopy. 2014; 30(11):1461-7. DOI: 10.1016/j.arthro.2014.05.041. View

Jepsen C, Lundberg-Jensen A, Faunoe P . Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? A clinical, prospective, randomized, double-blind study. Arthroscopy. 2007; 23(12):1326-33. DOI: 10.1016/j.arthro.2007.09.010. View

Loh J, Fukuda Y, Tsuda E, Steadman R, Fu F, Woo S . Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper. Arthroscopy. 2003; 19(3):297-304. DOI: 10.1053/jars.2003.50084. View

Heming J, Rand J, Steiner M . Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med. 2007; 35(10):1708-15. DOI: 10.1177/0363546507304137. View

Steiner M . Anatomic single-bundle ACL reconstruction. Sports Med Arthrosc Rev. 2009; 17(4):247-51. DOI: 10.1097/JSA.0b013e3181c0ccf8. View

10.

Alentorn-Geli E, Samitier G, Alvarez P, Steinbacher G, Cugat R . Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up. Int Orthop. 2010; 34(5):747-54. PMC: 2903180. DOI: 10.1007/s00264-010-1000-1. View

11.

Brophy R, Pearle A . Single-bundle anterior cruciate ligament reconstruction: a comparison of conventional, central, and horizontal single-bundle virtual graft positions. Am J Sports Med. 2009; 37(7):1317-23. DOI: 10.1177/0363546509333007. View

12.

Anderson A, Irrgang J, Kocher M, Mann B, Harrast J . The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med. 2005; 34(1):128-35. DOI: 10.1177/0363546505280214. View

13.

Franceschi F, Papalia R, Rizzello G, Del Buono A, Maffulli N, Denaro V . Anteromedial portal versus transtibial drilling techniques in anterior cruciate ligament reconstruction: any clinical relevance? A retrospective comparative study. Arthroscopy. 2013; 29(8):1330-7. DOI: 10.1016/j.arthro.2013.05.020. View

14.

Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski R, McMahon P . Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med. 2005; 33(5):712-8. DOI: 10.1177/0363546504271747. View

15.

Kim M, Lee B, Park J . Anatomic single bundle anterior cruciate ligament reconstruction by the two anteromedial portal method: the comparison of transportal and transtibial techniques. Knee Surg Relat Res. 2012; 23(4):213-9. PMC: 3341809. DOI: 10.5792/ksrr.2011.23.4.213. View

16.

Woo S, Kanamori A, Zeminski J, Yagi M, Papageorgiou C, Fu F . The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon . A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am. 2002; 84(6):907-14. DOI: 10.2106/00004623-200206000-00003. View

17.

Sim J, Gadikota H, Li J, Li G, Gill T . Biomechanical evaluation of knee joint laxities and graft forces after anterior cruciate ligament reconstruction by anteromedial portal, outside-in, and transtibial techniques. Am J Sports Med. 2011; 39(12):2604-10. PMC: 3740363. DOI: 10.1177/0363546511420810. View

18.

Robin B, Jani S, Marvil S, Reid J, Schillhammer C, Lubowitz J . Advantages and Disadvantages of Transtibial, Anteromedial Portal, and Outside-In Femoral Tunnel Drilling in Single-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review. Arthroscopy. 2015; 31(7):1412-7. DOI: 10.1016/j.arthro.2015.01.018. View

19.

Osaki K, Okazaki K, Matsubara H, Kuwashima U, Murakami K, Iwamoto Y . Asymmetry in Femoral Tunnel Socket Length During Anterior Cruciate Ligament Reconstruction With Transportal, Outside-In, and Modified Transtibial Techniques. Arthroscopy. 2015; 31(12):2365-70. DOI: 10.1016/j.arthro.2015.06.026. View

20.

Liu A, Sun M, Ma C, Chen Y, Xue X, Guo P . Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015; 25(9):2751-2759. DOI: 10.1007/s00167-015-3672-y. View