Comparison of Clinical Outcomes between Anteromedial and Transtibial Techniques of Single-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis

Abstract

This study compared clinical outcomes obtained after single-bundle anterior cruciate ligament (ACL) reconstruction using the anteromedial (AM) and transtibial (TT) techniques, which comprise the conventional transtibial (cTT) and modified transtibial (mTT) techniques. This study included clinical randomized controlled trials and prospective and retrospective controlled trials with AM and TT techniques from the PubMed and Embase databases and the Cochrane Library. All databases were searched from January 2010 to July 2020. Two independent evaluators verified the quality of the included studies using the Cochrane Collaboration’s risk of bias tool and the Newcastle-Ottawa Scale (NOS). Outcome measures analysed included the Lachman test, pivot-shift test, side-to-side difference (SSD), Lysholm score, Tegner activity scale, International Knee Documentation Committee (IKDC) grade and score. Ten randomized controlled trials (RCTs) and 16 prospective and retrospective controlled trials were included with a total of 2202 patients. There were 1180 patients and 1022 patients in the AM and TT groups, respectively. Compared to the cTT group, superior postoperative results were observed in the AM group based on the negative rate of the Lachman test and the pivot-shift test, IKDC grade and score, Lysholm score, Tegner activity scale and SSD (p < 0.05). However, there was no significant difference between the AM and mTT groups (p > 0.05). Compared to the conventional TT technique, the AM technique exhibited superior clinical outcomes. Nevertheless, the modified TT and AM techniques had comparable results. With neither of the techniques (mTT or AM) producing significantly superior outcomes, surgeons can choose either of them depending on their preferences.

Comparative study of the modified transtibial technique and the transportal technique in anterior cruciate ligament reconstruction

“…TP is a classic technique of anatomical reconstruction, which can directly create a femoral tunnel without a tibial tunnel, and the position of the intraarticular orifices of the tunnel is closer to the anatomical position. However, the TP technique also has its drawbacks, such as short tunnels and femoral condyle posterior wall blowouts (18). In addition, the extreme flexion of the knee joint during surgery may also result in a poor visual field and increase the risk of cartilage injury of the medial femoral condyle.…”

Minimizing the risk of graft failure after anterior cruciate ligament reconstruction in athletes. A narrative review of the current evidence

“…With improved understanding of the anatomy and biomechanics of the ACL, the transtibial approach has been modified to achieve a more anatomic femoral tunnel placement. The modified transtibial technique showed superior outcomes than conventional transtibial approach and comparable with the anteromedial portal technique in terms of clinical scores, negative rates of the Lachman and the pivot‐shift test, and return‐to‐sport level [69]. Future studies are needed to determine the long‐term benefits with the modified transtibial in terms of graft failure rates.…”