Skip to main content
Top
Published in: MUSCULOSKELETAL SURGERY 1/2016

01-04-2016 | Original Article

Outcome of arthroscopic single-bundle anterior cruciate ligament reconstruction: anteromedial portal technique versus transtibial drilling technique

Authors: S. Rezazadeh, H. Ettehadi, A. R. Vosoughi

Published in: MUSCULOSKELETAL SURGERY | Issue 1/2016

Login to get access

Abstract

Purpose

Controversies exist about the femoral tunnel preparation technique in anterior cruciate ligament (ACL) reconstruction surgeries. The aim of this study was to evaluate mid-term outcomes of transtibial (TT) technique in comparison with anteromedial portal (AMP) one.

Methods

Demographic data, height, weight, period of time from injury to surgery, and follow-up duration of patients underwent ACL reconstruction using single-bundle hamstring graft by the senior author between 2007 and 2011 were evaluated, retrospectively. Mid-quadriceps circumference difference, passive range of motion of the joint, anterior drawer test, Lachman test, and pivot shift test were assessed for each case. Function of the knee joint was calculated using International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores.

Results

Of 50 cases in the AMP group (age 30.6 ± 6.5), 45 were male and of the 44 patients in the TT group (age 30.0 ± 6.5), forty were male. Mean follow-up times in the AMP and TT group were 18.2 months (range 12–84 months) and 25.7 months (range 16–48 months), respectively. No statistically significant difference was found in mid-quadriceps circumference difference (P = 0.861). Also, functional knee scores (P values of IKDC = 0.329, Lysholm score = 0.08, Tegner = 0.504) and stability tests (P values of anterior drawer test = 0.07, Lachman test = 0.486, pivot shift test = 0.348) did not differ statistically between groups.

Conclusion

There is no superiority of AMP technique on TT technique in ACL reconstructive surgeries. It could be suggested that performing a well-done technique, either TT or AMP, may be more important than only choosing a technique.
Literature
3.
go back to reference Dragoo JL, Braun HJ, Durham JL, Chen MR, Harris AH (2012) Incidence and risk factors for injuries to the anterior cruciate ligament in National Collegiate Athletic Association football: data from the 2004–2005 through 2008–2009 National Collegiate Athletic Association Injury Surveillance System. Am J Sports Med 40:990–995. doi:10.1177/0363546512442336 CrossRefPubMed Dragoo JL, Braun HJ, Durham JL, Chen MR, Harris AH (2012) Incidence and risk factors for injuries to the anterior cruciate ligament in National Collegiate Athletic Association football: data from the 2004–2005 through 2008–2009 National Collegiate Athletic Association Injury Surveillance System. Am J Sports Med 40:990–995. doi:10.​1177/​0363546512442336​ CrossRefPubMed
4.
go back to reference Speziali A, Placella G, Tei MM, Georgoulis A, Cerulli G (2015) Diagnostic value of the clinical investigation in acute meniscal tears combined with anterior cruciate ligament injury using arthroscopic findings as golden standard. Musculoskelet Surg. 17 Feb 2015. [Epub ahead of print] Speziali A, Placella G, Tei MM, Georgoulis A, Cerulli G (2015) Diagnostic value of the clinical investigation in acute meniscal tears combined with anterior cruciate ligament injury using arthroscopic findings as golden standard. Musculoskelet Surg. 17 Feb 2015. [Epub ahead of print]
6.
go back to reference Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152CrossRefPubMed Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152CrossRefPubMed
7.
go back to reference Ruffilli A, Traina F, Evange listi G, Borghi R, Perna F, Faldini C (2015) Preservation of hamstring tibial insertion in anterior cruciate ligament reconstruction: a review of the current literature. Musculoskelet Surg 99:87–92. doi:10.1007/s12306-015-0346-3 CrossRefPubMed Ruffilli A, Traina F, Evange listi G, Borghi R, Perna F, Faldini C (2015) Preservation of hamstring tibial insertion in anterior cruciate ligament reconstruction: a review of the current literature. Musculoskelet Surg 99:87–92. doi:10.​1007/​s12306-015-0346-3 CrossRefPubMed
8.
go back to reference Speziali A, Delcogliano M, Tei M, Placella G, Bartoli M, Menghi A, Cerulli G (2014) Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies. Musculoskelet Surg 98:179–187. doi:10.1007/s12306-014-0338-8 CrossRefPubMed Speziali A, Delcogliano M, Tei M, Placella G, Bartoli M, Menghi A, Cerulli G (2014) Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies. Musculoskelet Surg 98:179–187. doi:10.​1007/​s12306-014-0338-8 CrossRefPubMed
9.
go back to reference Sohn DH, Garrett WE Jr (2009) Transitioning to anatomic anterior cruciate ligament graft placement. J Knee Surg 22:155–160CrossRefPubMed Sohn DH, Garrett WE Jr (2009) Transitioning to anatomic anterior cruciate ligament graft placement. J Knee Surg 22:155–160CrossRefPubMed
10.
go back to reference Strobel MJ, Castillo RJ, Weiler A (2001) Reflex extension loss after anterior cruciate ligament reconstruction due to femoral “high noon” graft placement. Arthroscopy 17:408–411CrossRefPubMed Strobel MJ, Castillo RJ, Weiler A (2001) Reflex extension loss after anterior cruciate ligament reconstruction due to femoral “high noon” graft placement. Arthroscopy 17:408–411CrossRefPubMed
11.
go back to reference Carson EW, Anisko EM, Restrepo C, Panariello RA, O’Brien SJ, Warren RF (2004) Revision anterior cruciate ligament reconstruction: etiology of failures and clinical results. J Knee Surg 17:127–132PubMed Carson EW, Anisko EM, Restrepo C, Panariello RA, O’Brien SJ, Warren RF (2004) Revision anterior cruciate ligament reconstruction: etiology of failures and clinical results. J Knee Surg 17:127–132PubMed
13.
go back to reference Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6:S2–S12CrossRefPubMed Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6:S2–S12CrossRefPubMed
14.
go back to reference Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628CrossRefPubMed Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628CrossRefPubMed
15.
go back to reference Yagi M, Kuroda R, Nagamune K, Yoshiya S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100–107CrossRefPubMed Yagi M, Kuroda R, Nagamune K, Yoshiya S, Kurosaka M (2007) Double-bundle ACL reconstruction can improve rotational stability. Clin Orthop Relat Res 454:100–107CrossRefPubMed
16.
go back to reference Xu M, Gao S, Zeng C, Han R, Sun J, Li H, Xiong Y, Lei G (2013) Outcomes of anterior cruciate ligament reconstruction using single-bundle versus double-bundle technique: meta-analysis of 19 randomized controlled trials. Arthroscopy 29:357–365. doi:10.1016/j.arthro.2012.08.024 CrossRefPubMed Xu M, Gao S, Zeng C, Han R, Sun J, Li H, Xiong Y, Lei G (2013) Outcomes of anterior cruciate ligament reconstruction using single-bundle versus double-bundle technique: meta-analysis of 19 randomized controlled trials. Arthroscopy 29:357–365. doi:10.​1016/​j.​arthro.​2012.​08.​024 CrossRefPubMed
17.
go back to reference Chen M, Dong QR, Xu W, Ma WM, Zhou HB, Zheng ZG (2010) Clinical outcome of single-bundle versus anatomic double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Zhonghua Wai Ke Za Zhi 48:1332–1336PubMed Chen M, Dong QR, Xu W, Ma WM, Zhou HB, Zheng ZG (2010) Clinical outcome of single-bundle versus anatomic double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis. Zhonghua Wai Ke Za Zhi 48:1332–1336PubMed
19.
go back to reference Asagumo H, Kimura M, Kobayashi Y, Taki M, Takagishi K (2007) Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy 23:602–609CrossRefPubMed Asagumo H, Kimura M, Kobayashi Y, Taki M, Takagishi K (2007) Anatomic reconstruction of the anterior cruciate ligament using double-bundle hamstring tendons: surgical techniques, clinical outcomes, and complications. Arthroscopy 23:602–609CrossRefPubMed
20.
go back to reference Ahn JH, Jeong HJ, Ko CS, Ko TS, Kim JH (2013) Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg 5:26–35. doi:10.4055/cios.2013.5.1.26 CrossRefPubMedPubMedCentral Ahn JH, Jeong HJ, Ko CS, Ko TS, Kim JH (2013) Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg 5:26–35. doi:10.​4055/​cios.​2013.​5.​1.​26 CrossRefPubMedPubMedCentral
22.
go back to reference Strauss EJ, Barker JU, McGill K, Cole BJ, Bach BR Jr, Verma NN (2011) Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? Am J Sports Med 39:1263–1269. doi:10.1177/0363546510395488 CrossRefPubMed Strauss EJ, Barker JU, McGill K, Cole BJ, Bach BR Jr, Verma NN (2011) Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring anterior cruciate ligament reconstruction? Am J Sports Med 39:1263–1269. doi:10.​1177/​0363546510395488​ CrossRefPubMed
23.
go back to reference Silva A, Sampaio R, Pinto E (2010) Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1245–1251. doi:10.1007/s00167-010-1132-2 CrossRefPubMed Silva A, Sampaio R, Pinto E (2010) Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1245–1251. doi:10.​1007/​s00167-010-1132-2 CrossRefPubMed
26.
go back to reference Gavriilidis I, Motsis EK, Pakos EE, Georgoulis AD, Mitsionis G, Xenakis TA (2008) Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study. Knee 15:364–367CrossRefPubMed Gavriilidis I, Motsis EK, Pakos EE, Georgoulis AD, Mitsionis G, Xenakis TA (2008) Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study. Knee 15:364–367CrossRefPubMed
28.
go back to reference Sedeek SM, Andrew THC (2013) Femoral tunnel drilling in anterior cruciate ligament reconstruction: anteromedial or transtibial portal?. Current review. Hard Tissue 2:34 Sedeek SM, Andrew THC (2013) Femoral tunnel drilling in anterior cruciate ligament reconstruction: anteromedial or transtibial portal?. Current review. Hard Tissue 2:34
29.
go back to reference Zhang Q, Zhang S, Li R, Liu Y, Cao X (2012) Comparison of two methods of femoral tunnel preparation in single-bundle anterior cruciate ligament reconstruction: a prospective randomized study. Acta Cir Bras 27:572–576CrossRefPubMed Zhang Q, Zhang S, Li R, Liu Y, Cao X (2012) Comparison of two methods of femoral tunnel preparation in single-bundle anterior cruciate ligament reconstruction: a prospective randomized study. Acta Cir Bras 27:572–576CrossRefPubMed
30.
go back to reference Azboy I, Demirtaş A, Gem M, Kıran S, Alemdar C, Bulut M (2014) A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up. Arch Orthop Trauma Surg 134:963–969. doi:10.1007/s00402-014-1996-6 CrossRefPubMed Azboy I, Demirtaş A, Gem M, Kıran S, Alemdar C, Bulut M (2014) A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up. Arch Orthop Trauma Surg 134:963–969. doi:10.​1007/​s00402-014-1996-6 CrossRefPubMed
31.
go back to reference Riboh JC, Hasselblad V, Godin JA, Mather RC 3rd (2013) Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression. Am J Sports Med 41:2693–2702. doi:10.1177/0363546513506979 CrossRefPubMed Riboh JC, Hasselblad V, Godin JA, Mather RC 3rd (2013) Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression. Am J Sports Med 41:2693–2702. doi:10.​1177/​0363546513506979​ CrossRefPubMed
32.
go back to reference Wei Z, Li F, Peng W, Wei B, Qiu L, Wei C (2014) Comparative study on arthroscopic anterior cruciate ligament reconstruction with transtibial technique and through anteromedial approach. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 28:339–344PubMed Wei Z, Li F, Peng W, Wei B, Qiu L, Wei C (2014) Comparative study on arthroscopic anterior cruciate ligament reconstruction with transtibial technique and through anteromedial approach. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 28:339–344PubMed
34.
go back to reference Mardani-Kivi M, Madadi F, Keyhani S, Karimi-Mobarake M, Hashemi-Motlagh K, Saheb-Ekhtiari K (2012) Antero-medial portal vs. transtibial techniques for drilling femoral tunnel in ACL reconstruction using 4-strand hamstring tendon: a cross-sectional study with 1-year follow-up. Med Sci Monit 18:CR674-9CrossRefPubMed Mardani-Kivi M, Madadi F, Keyhani S, Karimi-Mobarake M, Hashemi-Motlagh K, Saheb-Ekhtiari K (2012) Antero-medial portal vs. transtibial techniques for drilling femoral tunnel in ACL reconstruction using 4-strand hamstring tendon: a cross-sectional study with 1-year follow-up. Med Sci Monit 18:CR674-9CrossRefPubMed
36.
go back to reference Alentorn-Geli E, Lajara F, Samitier G, Cugat R (2010) The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1013–1037. doi:10.1007/s00167-009-0964-0 CrossRefPubMed Alentorn-Geli E, Lajara F, Samitier G, Cugat R (2010) The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1013–1037. doi:10.​1007/​s00167-009-0964-0 CrossRefPubMed
Metadata
Title
Outcome of arthroscopic single-bundle anterior cruciate ligament reconstruction: anteromedial portal technique versus transtibial drilling technique
Authors
S. Rezazadeh
H. Ettehadi
A. R. Vosoughi
Publication date
01-04-2016
Publisher
Springer Milan
Published in
MUSCULOSKELETAL SURGERY / Issue 1/2016
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-015-0392-x

Other articles of this Issue 1/2016

MUSCULOSKELETAL SURGERY 1/2016 Go to the issue