A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up

Azboy, İbrahim; Demirtaş, Abdullah; Gem, Mehmet; Kıran, Seymuz; Alemdar, Celil; Bulut, Mehmet

doi:10.1007/s00402-014-1996-6

Cited by 35 publications

(24 citation statements)

References 31 publications

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“…Although evaluation of the functional outcomes based on IKDC and Lysholm scores and Tegner activity levels revealed higher values in the AMP group, significant differences between the groups were not observed. This result is similar to the results of other studies with more than a year of follow-up time [ 11 , 29 , 32 , 33 ]. Conversely, there are studies with significantly higher IKDC and/or Lysholm scores following ACL reconstruction using the AMP technique [ 34 ].…”

Section: Discussionsupporting

confidence: 92%

“…On the other hand, numerous studies have suggested that the AMP technique facilitates a more anatomic and horizontal femoral tunnel, independent of tibial tunnel placement within the native ACL femoral attachment site, and provides greater rotational stability. Furthermore, these studies suggest that a more horizontal placement of the graft decreases the risk of graft impingement [ 10 , 29 , 30 ]. However, there are several potential surgical difficulties with regard to the AMP technique, including a short femoral tunnel, blow out of the back wall of the lateral femoral intercondylar notch, and difficulty with visualization and graft passage [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

Sukur

Akman²,

Senel³

et al. 2016

TOORTHJ

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Background:Among the many factors that determine the outcome following anterior cruciate ligament (ACL) reconstruction, the position of the femoral tunnel is known to be critically important and is still the subject of extensive research.Objective:We aimed to retrospectively compare the outcomes of arthroscopic ACL reconstruction using transtibial (TT) or anteromedial (AMP) drilling techniques for femoral tunnel placement.Methods:ACL reconstruction was performed using the TT technique in 49 patients and the AMP technique in 56 patients. Lachman and pivot-shift tests, the Lysholm Knee Scale, International Knee Documentation Committee (IKDC) score, Tegner activity scale and visual analog scale (VAS) were used for the clinical and functional evaluation of patients. Time to return to normal life and time to jogging were assessed in addition to the radiological evaluation of femoral tunnel placement.Results:In terms of the Lysholm, IKDC, Tegner score, and stability tests, no significant differences were found between the two groups (p > 0.05). Statistical analysis revealed reduced time to return to normal life and jogging in the AMP group (p < 0.05). The VAS score was also significantly reduced in the AMP group (p < 0.05). The position of the femoral tunnel was anatomically appropriate in 51 patients in the AMP group and 5 patients in the TT group.Conclusion:The AMP technique is superior to the TT technique in creating anatomical femoral tunnel placement during single-bundle ACL reconstruction and provides faster recovery in terms of return to normal life and jogging at short-term follow-up.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

Sukur

Akman²,

Senel³

et al. 2016

TOORTHJ

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“…Like several techniques of femoral tunneling, AMP drilling may provide improved rotation stability, decreased anterior translation and greater coverage of ACL’s anatomic footprint compared to TT techniques, but there is little evidence to support a clinical difference[6,9-12]. To this end, clinical outcomes of TT and AMP drilling techniques for ACL reconstruction were directly appraised in a 2016 systematic literature review, however all outcomes suggesting superior result of AMP drilling technique failed to surpass a minimal clinically important difference despite notable improvements based on the physical exam and scoring system results[6].…”

Section: Resultsmentioning

confidence: 99%

Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

Lacey

Lamplot

Walley

et al. 2017

WJO

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AIMTo describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail.METHODSOnce preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL’s anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft’s outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip stitched, quadrupled and shaped to match the diameter of the prepared femoral tunnel. If the diameter of the patient’s autologous hamstring graft is insufficient to fill the prepared femoral tunnel, the autograft may be supplemented with an allograft. The remainder of the reconstruction is performed according to surgeon preference.RESULTSThe presence of retained hardware presents a challenge for surgeons treating patients with knee instability. In cruciate ligament reconstruction, distal femoral and proximal tibial implants hardware may confound tunnel placement, making removal of hardware necessary, unless techniques are adopted to allow for anatomic placement of the graft.CONCLUSIONThis report demonstrates how the femoral tunnel can be created using the anteromedial portal instead of a transtibial approach for reconstruction of the ACL.

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“…Few other studies did not find any significant difference between both the techniques on the basis of IKDC, Lysholm and Tegner scale scores. [22][23][24] Smaller sample size, less adequate measurement of the degree of post-operative stability and less duration of follow-up remains the limitations of the study.…”

Section: Discussionmentioning

confidence: 99%

Anteromedial versus trans-tibial technique for anterior cruciate ligament reconstruction using quadrupled hamstring graft: a comparative study

Singh¹,

Sharma

Akshay³

2019

Int J Res Orthop

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Background: Femoral tunnel position plays a pivotal role for successful outcome in anterior cruciate ligament (ACL) reconstruction surgeries. Recently, the anteromedial techniques have gained popularity over the trans-tibial technique due to better anatomical position and better stability rotationally and antero-posteriorly then the later. The aim of the present study was to compare the technical difficulty and ease, functional and radiological outcome of trans-tibial and anteromedial portal techniques in ACL reconstruction.Methods: Thirty patients between March 2015 and February 2016 with ACL tear underwent arthroscopic reconstruction using quadrupled hamstring graft and were divided into two groups A (anteromedial) and group B (trans-tibial) as per the technique used. Patients with multiligament injuries, revision surgeries, and osteoarthritis knee were excluded. All the patients were followed-up for 24 months and clinical Lysholm and IKDC scores along with radiological outcome were calculated.Results: The mean age of patients were 32.4±6.3 years. Isolated ACL tear was seen in 16 (53.4%) cases followed by medial meniscus injury in 11 (36.6%) patients. The mean duration between injury and surgery was 14.8±8.99 and 21.6±3.23 days in group A and B respectively (p=0.0122). The radiological position of femoral tunnel in sagittal and coronal plane was statistically significant in both the groups. The Lysholm and IKDC scores showed statistically significant difference at 3 months post-operatively.Conclusions: Anteromedial and trans-tibial techniques have similar long term functional outcomes. However, more anatomical position of the graft through the anteromedial technique and better rotational and anteroposterior stability makes it theoretically to be superior to the trans-tibial technique.

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A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up

Abstract: It was shown that AMP technique was superior to the TT technique in providing anatomical placement of the graft and in recovery time to return sports; however, there was no difference between groups in early periods in terms of the clinical and functional outcomes.

Cited by 35 publications

References 31 publications

Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

Comparing Transtibial and Anteromedial Drilling Techniques for Single-bundle Anterior Cruciate Ligament Reconstruction

Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

Anteromedial versus trans-tibial technique for anterior cruciate ligament reconstruction using quadrupled hamstring graft: a comparative study

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