Purpose
The purpose of this study was to compare clinical outcomes after single-bundle anterior
cruciate ligament (ACL) reconstruction with a free Achilles tendon allograft using
either a transtibial or an anteromedial portal technique and then to quantify the
difference in femoral tunnel position between these 2 approaches. This assessment
was to be performed with a new method using conventional magnetic resonance imaging
(MRI) with a digital imaging system.
Methods
In this prospective randomized comparative study, 53 young male patients with ACL
rupture underwent ACL reconstruction with the transtibial technique (group 1) or the
anteromedial portal technique (group 2). We assessed clinical outcomes with the Lachman
test, pivot shift test, International Knee Documentation Committee (IKDC) classification,
Lysholm score, Tegner activity scale, and single leg hop (SLH) test. Radiologic assessments
included the position of the femoral tunnel aperture and the posterior cruciate ligament
(PCL) index on conventional MRI and the side-to-side difference (SSD) on stress radiographs.
Results
Sixty-one participants had follow-up. The mean follow-up period was 30.2 months. At
the last follow-up, there were no significant differences between the 2 groups in
results from the Lachman test, pivot shift test, IKDC classification, Tegner activity
scale, and SLH test. The Lysholm score and SSD results in group 2 were superior to
those in group 1 (P < .001). The femoral tunnel aperture was positioned more posteriorly in group 2 than
in group 1 (P < .001). Changes in the PCL index were greater in group 1 than in group 2 (P < .001).
Conclusions
The position of the femoral tunnel aperture created with the anteromedial portal technique
was more posterior than that made with the transtibial technique. Knees reconstructed
with the anteromedial portal technique were more stable in Telos testing, and were
3 points higher on the Lysholm score. However, there were no statistically significant
differences in the Tegner activity scale or IKDC classification between the 2 groups.
Level of Evidence
Therapeutic level I, randomized controlled clinical trial.
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References
- Prospective evaluation of patients with anterior cruciate ligament reconstruction using a patient-based health-related survey: comparison of single-bundle and anatomical double-bundle techniques.Arch Orthop Trauma Surg. 2012; 132: 393-398
- Single- versus double-bundle ACL reconstruction: is there any difference in stability and function at 3-year follow-up?.Clin Orthop Relat Res. 2012; 470: 823-834
- Evaluation of tibial rotational stability of single-bundle vs. anatomical double-bundle anterior cruciate ligament reconstruction during a high-demand activity—a quasi-randomized trial.Knee. 2012; 19: 87-93
- The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1013-1037
- The anteromedial portal for drilling of the femoral tunnel for anterior cruciate ligament reconstruction.Tech Orthop. 2005; 20: 228-229
- Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study.Knee. 2008; 15: 364-367
- Comparison of 4 femoral tunnel drilling techniques in anterior cruciate ligament reconstruction.Arthroscopy. 2012; 28: 972-979
- ACL reconstruction: comparison between transtibial and anteromedial portal techniques.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 896-903
- Correlation between anterior cruciate ligament graft obliquity and tibial rotation during dynamic pivoting activities in patients with anatomic anterior cruciate ligament reconstruction: an in vivo examination.Arthroscopy. 2012; 28: 234-246
- Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction.Arthroscopy. 2007; 23: 771-778
- Current trends in anterior cruciate ligament reconstruction. Part II. Operative procedures and clinical correlations.Am J Sports Med. 2000; 28: 124-130
- Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 2200-2207
- Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction?.Am J Sports Med. 2011; 39: 1263-1269
- Anterior cruciate ligament reconstruction: can anatomic femoral placement be achieved with a transtibial technique?.Am J Sports Med. 2011; 39: 1306-1315
- Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography.J Bone Joint Surg Am. 2010; 92: 1427-1431
- Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation.Knee Surg Sports Traumatol Arthrosc. 2009; 17: 220-227
- The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction.Am J Sports Med. 2001; 29: 567-574
- Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks.Arthroscopy. 2004; 20: 328-330
- ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1551-1558
- Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction.Am J Sports Med. 2007; 35: 1708-1715
- Double-bundle “anatomic” anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique.Arthroscopy. 2007; 23: 7-13
- Anterior cruciate ligament tear. A new diagnostic index on magnetic resonance imaging.Clin Orthop Relat Res. 1994; 302: 147-150
- Anterior cruciate ligament reconstruction: MR imaging signs of anterior knee laxity in the presence of an intact graft.Radiology. 2012; 263: 802-810
- An evaluation of reconstructed ACL impingement on PCL using MRI.Magn Reson Imaging. 2007; 25: 722-726
- Second-look arthroscopy of anterior cruciate ligament grafts with multistranded hamstring tendons.Arthroscopy. 2004; 20: 287-293
- 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: 2604-2610
- Comparison of femoral graft bending angle and tunnel length between transtibial technique and transportal technique in anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1584-1593
- Comparison of anterior cruciate ligament tunnel position and graft obliquity with transtibial and anteromedial portal femoral tunnel reaming techniques using high-resolution magnetic resonance imaging.Arthroscopy. 2011; 27: 1511-1522
- Anterior cruciate ligament femoral tunnel length: cadaveric analysis comparing anteromedial portal versus outside-in technique.Arthroscopy. 2010; 26: 1357-1362
- A comparison of 2 drilling techniques on the femoral tunnel for anterior cruciate ligament reconstruction.Arthroscopy. 2011; 27: 372-379
- Comparisons of femoral tunnel position and length in anterior cruciate ligament reconstruction: modified transtibial versus anteromedial portal techniques.Arthroscopy. 2011; 27: 1389-1394
- Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique.Arthroscopy. 2011; 27: 380-390
- Impact of tibial and femoral tunnel position on clinical results after anterior cruciate ligament reconstruction.Arthroscopy. 2011; 27: 355-364
- Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis.Arthroscopy. 2011; 27: 1259-1267
- Anterior cruciate ligament tunnel position measurement reliability on 3-dimensional reconstructed computed tomography.Arthroscopy. 2011; 27: 391-398
Article info
Publication history
Published online: March 28, 2013
Accepted:
January 22,
2013
Received:
April 6,
2012
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
