Purpose
To compare anteromedial (AM) and transtibial (TT) femoral drilling hole techniques
in primary anterior cruciate ligament reconstruction, using the Danish Knee Ligament
Reconstruction Register, comparing revision rates and clinical outcomes from 2 time
periods, 2007 to 2010 and 2012 to 2015.
Methods
A total of 8,386 primary anterior cruciate ligament reconstructions were registered
between January 2007 to December 2010 and 8,818 in the period January 2012 to December
2015. Revision ACL was the primary endpoint. Secondary endpoints were the objective
and subjective clinical outcomes. Crude and adjusted relative risks (RRs) with 95%
confidence interval (CIs) were calculated.
Results
The adjusted RR for revision surgery in the AM (2007-10) group compared with the TT
(2007-10) group was 1.45 (95% CI, 1.17-1.78; P < .05), but when comparing the AM (2012-15) group with TT (2012-15) group, the RR
was 0.99 (95% CI, 0.68-1.45; P = .96). One-year postoperative objective stability testing showed an RR = 1.38 (95%
CI, 1.19-1.60; P < .01) for rotational stability and an RR = 1.37 (95% CI, 0.99-1.89; P < .01) for sagittal stability when comparing AM (2007-10) to TT (2007-10). No significant
difference in objective stability was found in the more recent period. Lastly, comparing
the subjective scores, the AM (2012-15) had a significantly higher Tegner score 1 year
postoperatively compared with the TT-group (2012-15).
Conclusions
This study found an increased RR of revision anterior cruciate ligament and rotational
and sagittal instability 1 year postoperatively for the AM technique in the period
from 2007 to 2010. However, there was no significant difference in revision surgery
and objective measures between the techniques from 2012 to 2015. Nevertheless, a higher
activity level was found in the AM group. The results could indicate that the results
found in the period 2007 to 2010 may have been caused by a learning curve when introducing
a new and more complex procedure (AM).
Level of Evidence
Level III, retrospective comparative trial.
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Article info
Publication history
Accepted:
August 8,
2018
Received:
March 13,
2018
Footnotes
See commentary on page 190
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2018 Published by Elsevier on behalf of the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Anteromedial Femoral Socket Drilling in Anterior Cruciate Ligament Reconstruction … Love the Way You AreArthroscopyVol. 35Issue 1
- PreviewThe goal of the anterior cruciate ligament reconstruction is to avoid a permanent pivot shift. There are no significant differences in the clinical outcomes between performing anterior cruciate ligament reconstruction using anteromedial or transtibial technique in performing femoral socket. Although most previous studies have shown better results in avoiding pivot shift using the anteromedial technique, its clinical significance still needs to be determined and, in my opinion, the transtibial technique still remains the gold standard.
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