No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction: a prospective randomized, controlled trial

MacDonald, Peter B.; Kim, Christopher; McRae, Sheila; Leiter, Jeff; Khan, Ryan; Whelan, Daniel B.

doi:10.1007/s00167-017-4664-x

Cited by 27 publications

(17 citation statements)

References 45 publications

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“…29 While studies can be found to support either technique, recent prospective randomized studies have found no difference in clinical outcomes between anteromedial and transtibial femoral drilling techniques. 23 This was echoed by the present study, as no difference in RTS rates or performance upon RTS was seen between transtibial and anteromedial drilling techniques. Hence, surgeons performing ACLR in these athletes should use the technique with which they are most familiar and technically comfortable, as the ability to technically execute ACLR well seems to be more important than the actual femoral drilling technique.…”

Section: Discussionsupporting

confidence: 62%

Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Professional Baseball Players

Erickson

Chalmers

D’Angelo

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:Anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for ACL tears to allow baseball players to return to sport (RTS). The optimal graft type and femoral tunnel drilling technique are currently unknown.Hypothesis:There is a high rate of RTS in professional baseball players after ACLR, with no significant difference in RTS rates or performance between cases and controls or between graft types or femoral drilling techniques.Study Design:Cohort study; Level of evidence, 3.Methods:All professional baseball players who underwent ACLR between 2010 and 2015 were included. Demographic and performance data (pre- and postoperative) for each player were recorded. Performance metrics were then compared between cases and matched controls.Results:A total of 124 players (mean age, 23.7 ± 4.1 years; 83% minor league players) underwent ACLR. Of these, 80% returned to sport (73% to the same or higher level) at a mean 310 ± 109 days overall and 333 ± 126 days at the same or higher level. The most common graft type was an ipsilateral bone–patellar tendon–bone (BTB) autograft (n = 87; 70%). A total of 91 players underwent concomitant meniscal debridement or repair. No significant difference in any of the primary performance metrics existed from before to after ACLR. Compared with matched controls, no significant difference existed in RTS rates or any performance metrics after ACLR. No significant difference existed in RTS rates or primary performance outcome measures between graft types or femoral drilling techniques.Conclusion:The RTS rate for professional baseball players after ACLR was 80%. No significant difference in performance metrics existed between BTB and hamstring autografts or between femoral drilling techniques. Furthermore, no significant difference in performance or RTS rates existed between cases and matched controls. Femoral drilling technique and graft type did not affect performance and RTS rates in professional baseball players after ACLR.

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Section: Discussionsupporting

confidence: 62%

Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Professional Baseball Players

Erickson

Chalmers

D’Angelo

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…In total, 17 studies § § (68% of all clinical studies) used the IKDC system, and 10 studies 7,21,24,28,37,45,72,74,78,83 reported the grade results: A, normal; B, nearly normal; C, abnormal; and D, severely abnormal (Supplemental Table S3). A total of 7 studies 3,6,17,31,43,44,48 included subjective scores in their results. Fewer patients had IKDC grade A/B after the TT technique than after the AM technique, but no intergroup difference was found in IKDC scores (n ¼ 579; WMD, À2.54 [95% CI, À5.12 to 0.04]; P ¼ .001) (Figure 3C).…”

Section: Functional Outcomes: Scoring Systemsmentioning

confidence: 99%

Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review

Loucas

D’Ambrosi

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The drilling technique used to make a femoral tunnel is critically important for determining outcomes after anterior cruciate ligament (ACL) reconstruction. The 2 most common methods are the transtibial (TT) and anteromedial (AM) techniques. Purpose: To determine whether graft orientation and placement affect clinical outcomes by comparing clinical and radiological outcomes after single-bundle ACL reconstruction with the AM versus TT technique. Study Design: Systematic review; Level of evidence, 3. Methods: Articles in PubMed, EMBASE, the Cochrane Library, ISI Web of Science, Scopus, and MEDLINE were searched from inception until April 25, 2020, using the following Boolean operators: transtibial OR trans-tibial AND (anteromedial OR trans-portal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. Results: Of 1270 studies retrieved, 39 studies involving 11,207 patients were included. Of these studies, 14 were clinical, 13 were radiological, and 12 were mixed. Results suggested that compared with the TT technique, the AM technique led to significantly improved anteroposterior and rotational knee stability, International Knee Documentation Committee (IKDC) scores, and recovery time from surgery. A higher proportion of negative Lachman ( P = .0005) and pivot-shift test ( P = .0001) results, lower KT-1000 arthrometer maximum manual displacement ( P = .00001), higher Lysholm score ( P = .001), a higher incidence of IKDC grade A/B ( P = .05), and better visual analog scale score for satisfaction ( P = .00001) were observed with the AM technique compared with the TT technique. The AM drilling technique demonstrated a significantly shorter tunnel length ( P = .00001). Significant differences were seen between the femoral and tibial graft angles in both techniques. Low overall complication and revision rates were observed for ACL reconstruction with the AM drilling technique, similar to the TT drilling technique. Conclusion: In single-bundle ACL reconstruction, the AM drilling technique was superior to the TT drilling technique based on physical examination, scoring systems, and radiographic results. The AM portal technique provided a more reproducible anatomic graft placement compared with the TT technique.

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“…Two similar studies published in 2013 [20] and 2015 [21] evaluated the mechanical functions of AM and posterolateral (PL) bands. Both studies found that the AM band presents greater anteroposterior and rotational stability.…”

Section: Discussionmentioning

confidence: 99%

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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No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction: a prospective randomized, controlled trial

Abstract: I.

Cited by 27 publications

References 45 publications

Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Professional Baseball Players

Performance and Return to Sport After Anterior Cruciate Ligament Reconstruction in Professional Baseball Players

Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review

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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