Comparative evaluation of the results of three techniques in the reconstruction of the anterior cruciate ligament, with a minimum follow-up of two years

Cury, Ricardo de Paula Leite; Sprey, Jan Willem Cerf; Bragatto, André Luiz Lima; Mansano, Marcelo Valentim; Moscovici, Herman Fabian; Guglielmetti, Luiz Gabriel Betoni

doi:10.1016/j.rboe.2017.05.003

Cited by 5 publications

(2 citation statements)

References 23 publications

(36 reference statements)

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“…18 Although Kim et al 18 found a difference in the IKDC objective score favoring the outside-in technique, no significant differences for functional, clinical, and imaging postoperative outcomes have been reported. 5,18 The present meta-analysis corroborates the finding that there are no significant differences between transportal and outside-in techniques.…”

Section: Discussionsupporting

confidence: 88%

Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis

Fernandes

Moreira

Andrade

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Purpose: To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction. Study Design: Systematic review; Level of evidence, 3. Methods: A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score for randomized controlled trials. Results: Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference, –0.14; 95% confidence interval, –0.27 to –0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test. Conclusion: Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.

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Section: Discussionsupporting

confidence: 88%

Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis

Fernandes

Moreira

Andrade

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…All cases included were operated by the same surgeon (R.P.L.C.). The transtibial technique in femoral double bundle 11 )- ( 13 with autologous quadriceps and semitendinosus grafts from patients’ ipsilateral knees or bilateral flexor tendons were used in PCL reconstructions (group 1), whereas the “outside-in” ( 14 technique with autografts from ipsilateral flexor tendons was used in ACL reconstructions (group 2). If grafts only included flexor tendons, anterolateral bundles were reconstructed with two semitendinosus grafts and posteromedial ones with two gracilis ones.…”

Section: Methodsmentioning

confidence: 99%

Posterior Cruciate Ligament Reconstruction: Are the Results Similar to Anterior Cruciate Ligament Reconstruction?

et al. 2023

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Objective: To report and compare the results of posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) reconstructions. Methods: In total, 42 patients were retrospectively evaluated, 20 with isolated PCL injuries (group 1) and 22 with isolated ACL ones (group 2) who were subjected to arthroscopic ligament reconstruction with autologous grafts and followed up for at least two years. To evaluate the results in group 1, objective IKDC and Lysholm scores, posterior drawer tests, and evaluations by a KT-1000 arthrometer were used, whereas for group 2, subjective IKDC and Lysholm score and the Lachman test were employed. To compare groups, objective IKDC and Lysholm scores and assessment via a KT-1000 arthrometer were considered. Results: Intragroup analysis showed improved results for all variables (p < 0.001) in both groups. Comparisons between groups showed a significant difference in objective IKDC scores (p < 0.001), but no such disparities for Lysholm ones (p = 0.052), clinical tests (p = 0.058) or evaluation by KT-1000 (p = 0.129). Conclusion: Treatment restored knee stability and function in both groups. Comparisons between groups showed that PCL reconstructions had inferior results than ACL ones according to patients’ objective IKDC scores. Level of Evidence II, Retrospective Study.

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Anteromedial positioning of the femoral tunnel in anterior cruciate ligament reconstruction is the best option to avoid revision: a single surgeon registry

et al. 2020

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The aim of the study is to compare the risk of revision of single-bundle hamstring anterior cruciate ligament (ACL) reconstruction between the anteromedial, transtibial and outside-in techniques. Methods: This cohort study was based on data from a single surgeon's registry. Patients who underwent primary single-bundle ACL reconstruction with hamstring tendon using the anteromedial portal, transtibial and outside-in technique, operated between 1 November 2003 to 31 December 2016, were eligible for inclusion. A minimum follow-up of 2 years was used, and the end-point of the study was revision surgery. Results: The total number of registered surgeries identified was 665; 109 were excluded, and 556 was the final sample. The overall revision rate was 8.7%. The transtibial technique presented 14/154 [9.9%] of revisions, the transportal 11/96 [11.4%] and the outside-in 22/306 [7.2%]. Separating the outside-in group into central outside-in and anteromedial (AM) outside-in, 18/219 [8.2%] was found for the central outside-in and 4/87 [4.5%] for the AM outside-in technique. Statistical evaluation of the first comparison (transtibial vs. transportal vs. outside-in) obtained p = (n.s.) The second comparison (transtibial vs. central transportal vs. central outside-in vs. AM outside-in, p = (n.s). Placement was also evaluated: high anteromedial placement (transtibial) vs. central (transportal and central outsidein technique) vs. AM placement (AM outside-in). The high AM placement presented 14/154 [9.9%] of revision, the central placement 29/315 [9.2%] and the AM placement 4/87 [4.5%], p = (n.s.) The AM placement was also compared with the other placements (high and central AM), p = (n.s.) Conclusion: Based on the registry of a single surgeon during 14 years of ACL reconstruction, the placement of the femoral tunnel in the high anteromedial region was associated with a rupture rate of 9.9%, central placement with 9.2% and anteromedial placement with 4.5%.

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Comparative evaluation of the results of three techniques in the reconstruction of the anterior cruciate ligament, with a minimum follow-up of two years

Cited by 5 publications

References 23 publications

Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis

Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis

Posterior Cruciate Ligament Reconstruction: Are the Results Similar to Anterior Cruciate Ligament Reconstruction?

Anteromedial positioning of the femoral tunnel in anterior cruciate ligament reconstruction is the best option to avoid revision: a single surgeon registry

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