Anterior cruciate ligament reconstruction: a new cortical suspension device for femoral fixation with transtibial and transportal techniques

Guglielmetti, Luiz Gabriel Betoni; Cury, Ricardo de Paula Leite; Oliveira, Victor Marques de; Camargo, Osmar Pedro Arbix de; Severino, Nilson Roberto; Fucs, Patrícia Maria de Moraes Barros

doi:10.1186/s13018-014-0110-7

Cited by 16 publications

(12 citation statements)

References 20 publications

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“…The surgical technique involved arthroscopy, treatment of eventual meniscal and chondral injuries, and ACL reconstruction with fixation of the flexor tendon graft (semitendinosus and gracilis) on the tibia with a metal interference screw. In the femur, an Endo Tunnel Device (ETD ® ; ProInd, Cotia, São Paulo, Brazil), a suspension femoral fixation system 15 , was used (Figures 2-4). The tibial tunnel was drilled with the knee in extension, using the guide in extension (65° Howell Guide ® ; Biomet Sports Medicine Inc., Warsaw, IN).…”

Section: Methodsmentioning

confidence: 99%

Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Guglielmetti

Cury

Oliveira

et al. 2016

Rev Bras Med Esporte

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Introduction: Although the results of anterior cruciate ligament (ACL) reconstruction are well documented in many studies, with good to excellent outcomes in most cases, some issues like tunnel positioning are still discussed and studied. Objective: To compare the objective and subjective clinical outcomes of ACL reconstruction using the transtibial and anteromedial portal techniques. Methods: Prospective randomized study of 80 patients undergoing anterior cruciate ligament reconstruction by the same surgeon, with 40 patients operated by the transtibial technique and 40 by anteromedial portal technique. The patients, 34 in the transtibial group and 37 in the anteromedial portal group (nine dropouts), were reassessed during a 2-year follow-up period. The clinical assessment consisted of physical examination, KT-1000TM evaluation, Lysholm score, and objective and subjective International Knee Documentation Committee -IKDC scores. Results: Regarding the Lachman and pivot shift tests, we observed more cases of instability in the transtibial group, but with no statistical significance (p=0.300 and p=0.634, respectively). Regarding the anterior drawer test, the groups presented similar results (p=0.977). Regarding KT-1000TM evaluation, the mean results were 1.44 for the transtibial group and 1.23 for the anteromedial portal group, with no statistical significance (p=0.548). We separated the objective IKDC scores into two groups: Group 1, IKDC A, and Group 2, IKDC B, C, or D, with no statistical significance (p=0.208). Concerning the Lysholm score, the transtibial group had a mean score of 91.32, and the anteromedial portal group had a mean score of 92.81. The mean subjective IKDC scores were 90.65 for the transtibial group and 92.65 for the anteromedial portal group. Three re-ruptures were encountered in the transtibial group and three in the anteromedial portal group. Conclusions: There were no significant differences in the subjective and objective clinical assessments among patients submitted to anterior cruciate ligament reconstruction using the transtibial or anteromedial portal techniques.

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Section: Methodsmentioning

confidence: 99%

Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Guglielmetti

Cury

Oliveira

et al. 2016

Rev Bras Med Esporte

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“…There are few newer devices available for ACLR, which would need further research and follow-up. The Endo Tunnel Device® (ETD) (ProInd, Cotia, São Paulo, Brazil, ) is a new cortical suspension device for femoral fixation described by Guglielmetti, et al [ 30 ]. They found ETD to be a safe femoral fixation device; its use in both the trans-tibial and transportal techniques is technically simple and is associated with few intra- or postoperative complications.…”

Section: Reviewmentioning

confidence: 99%

Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

Vaishya

Ingole

et al. 2015

Cureus

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Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR.

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“…Traditionally, a transtibial (TT) technique of the femoral tunnel is the most common method used in single-bundle ACL reconstruction [ 8 – 10 ]. However, recent studies have shown that using the TT technique may lead to nonanatomic [ 11 , 12 ], usually anteriorly positioned femoral tunnels [ 5 , 10 , 13 – 15 ]. To address problems related to the TT technique, more attention has been paid to the anatomic and biomechanical factors to ensure a successful outcome in ACL reconstruction techniques [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials

Chen

Tie

et al. 2017

J Orthop Surg Res

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BackgroundThe aim of this study was to compare the clinical outcome and postoperative complication between single-bundle anterior cruciate ligament (ACL) reconstruction with an anteromedial (AM) technique and a transtibial (TT) technique.MethodsThe study includes clinical randomized controlled trials comparing the clinical outcomes of ACL reconstruction using the autologous hamstring tendon with an AM method and a TT method published up to September 2017 were retrieved from PubMed, Cochrane Library, and Embase databases. Relevant data were extracted and the Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality. Stata/SE 12.0 was used to perform a meta-analysis of the clinical outcome.ResultsFive RCTs were included, with a total of 479 patients: 239 patients and 240 patients in the AM group and the TT group, respectively. Assessing postoperative stability, better results were found in the AM group for the negative rate of the Lachman test (P < 0.05), the negative rate of the pivot-shift test (P < 0.05) and the side-to-side difference (P < 0.05). Assessing postoperative functional outcome, the AM group yielded superior results in proportion with International Knee Documentation Committee (IKDC) grade A (P < 0.05) and the Lysholm scores (P < 0.05) but had a comparable IKDC score (P > 0.05). In terms of postoperative complication, no significant difference was found between the AM group and the TT group (P > 0.05).ConclusionsThe outcome of single-bundle ACL reconstruction with the AM technique is better than that with the TT technique in terms of postoperative stability and functional recovery of the knee.

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Anterior cruciate ligament reconstruction: a new cortical suspension device for femoral fixation with transtibial and transportal techniques

Cited by 16 publications

References 20 publications

Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials

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