Comparison of femoral tunnel length and obliquity of anatomic versus nonanatomic anterior cruciate ligament reconstruction: A meta-analysis

Abstract

Theoretical considerations suggest that femoral tunnel length might cause graft mismatch, and femoral tunnel obliquity could be related to the longevity of graft in anterior cruciate ligament (ACL) reconstruction. However, controversy still exists regarding these issues in the context of the comparison of anatomic and nonanatomic ACL reconstructions. The purpose of this meta-analysis was to compare the length and obliquity of the femoral tunnel created by drilling through either anatomic or nonanatomic ACL reconstructions. Materials and method In this meta-analysis, we reviewed studies that compared femoral tunnel length and femoral tunnel obliquity in the coronal plane with the use of anatomic or nonanatomic ACL reconstruction. The major databases were reviewed for appropriate studies from the earliest available date of indexing through December 31, 2018. No restrictions were placed on the language of publication. Results Twenty-seven studies met the criteria for inclusion in this meta-analysis. The femur tunnel length of anatomic ACL reconstruction was significantly shorter compared with that of nonanatomic ACL reconstruction by 8.66 mm (95% CI: 7.10-10.22 mm; P<0.001), while the femur tunnel obliquity in the coronal plane of anatomic ACL reconstruction was significantly more oblique versus that of nonanatomic ACL reconstruction by 15.29˚(95% CI: 8.07˚-22.52˚; P<0.001). Similar results in terms of femoral tunnel length were found for the subgroup with cadaveric (7.15 mm; 95% CI: 2.69-11.61 mm; P = 0.002) and noncadaveric (8.96 mm; 95%

Six Percent Incidence of Graft-Tunnel Mismatch in Anatomic Anterior Cruciate Ligament Reconstruction Using Bone-Patella Tendon-Bone Autograft and Anteromedial Portal Drilling

“…However, over the past two decades, there has been increased use of anteromedial portal methods to drill femoral tunnels in ACLR. This shift in technique is in accordance with evidence that anteromedial portal drilling can change the position, length, and obliquity of the femoral tunnel in comparison to transtibial drilling, 7 , 8 , 9 position the tunnel at the center of the native ACL attachment site, 10 , 11 recreate the anisometry of the native ACL compared to transtibial techniques 12 , 13 , and thus, potentially influence mismatch 14 , 15 , although evidence of clinically superior outcomes is lacking. 16 However, the true incidence of mismatch using anteromedial drilling techniques is unknown.…”

Viral and atypical respiratory co‐infections in COVID‐19: a systematic review and meta‐analysis

“…With the Newcastle‐Ottawa Scale, studies received up to 9 points based on study subjects, study comparability, and outcome of interest assessment. A Newcastle‐Ottawa Scale of 0–6 indicates a high risk of bias, and 7–9 indicates a low risk of bias 19‐21 . For GRADE and Newcastle‐Ottawa Scale assessments, any disagreement between the 2 independent reviewers was settled by a third reviewer.…”