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Anteromedial Portal Technique, but Not Outside-in Technique, Is Superior to Standard Transtibial Technique in Knee Stability and Functional Recovery After Anterior Cruciate Ligament Reconstruction: A Network Meta-analysis

  • Haoran Feng
    Affiliations
    Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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  • Ning Wang
    Affiliations
    Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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  • Dongxing Xie
    Affiliations
    Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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  • Zidan Yang
    Affiliations
    Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
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  • Chao Zeng
    Affiliations
    Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

    Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China

    Hunan Engineering Research Center for Osteoarthritis, Changsha, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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  • Guanghua Lei
    Affiliations
    Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

    Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China

    Hunan Engineering Research Center for Osteoarthritis, Changsha, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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  • Hui Li
    Correspondence
    Address correspondence to Hui Li, M.D., Ph.D., Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
    Affiliations
    Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

    Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China

    Hunan Engineering Research Center for Osteoarthritis, Changsha, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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  • Yilun Wang
    Affiliations
    Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China

    Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China

    Hunan Engineering Research Center for Osteoarthritis, Changsha, China

    National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
    Search for articles by this author
Published:December 07, 2022DOI:https://doi.org/10.1016/j.arthro.2022.11.026

      Purpose

      To compare the postoperative outcomes of 4 different femoral drilling techniques in anterior cruciate ligament reconstruction.

      Methods

      Three databases were searched for randomized controlled trials comparing any 2 or more of the following femoral drilling techniques in anterior cruciate ligament reconstruction: standard transtibial (sTT), anteromedial portal (AMP), outside-in (OI), or modified transtibial (mTT) technique. A Bayesian network meta-analysis was performed to assess postoperative stability and functional recovery in terms of the side-to-side difference (measured by arthrometry), Lachman test, pivot-shift test, International Knee Documentation Committee subjective and objective scores, Lysholm score, and Tegner score. The Fisher exact probability test and χ2 test were used to compare the incidences of infection and graft rupture, respectively.

      Results

      We included 20 randomized controlled trials involving 1,515 patients. The AMP technique showed a lower side-to-side difference (standardized mean difference, –0.33; 95% credible interval [CrI], –0.53 to –0.12), higher negative rate on the pivot-shift test (odds ratio, 2.19; 95% CrI, 1.38 to 3.44), and higher International Knee Documentation Committee objective score (odds ratio, 3.13; 95% CrI, 1.42 to 7.82) than the sTT technique. However, knee stability and functional outcomes did not differ significantly between the OI and sTT techniques. Safety outcomes of the mTT technique were unavailable. The incidence of graft rupture was 5.20% for the OI technique, 2.27% for the AMP technique, and 1.51% for the sTT technique. The OI technique had a significantly higher incidence of graft rupture than the sTT technique (χ2 = 4.421, P = .035). No significant difference in the incidence of infection was found between the sTT, AMP, and OI techniques (P = .281).

      Conclusions

      The AMP technique, but not the OI technique, was superior to the sTT technique in knee stability and functional recovery. The OI technique had a higher incidence of graft rupture than the sTT technique. There was no significant difference between the AMP and OI techniques or between the mTT technique and any other femoral drilling technique.

      Level of Evidence

      Level II, meta-analysis of Level I and II studies.
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