Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique

Başdelioğlu, Koray; Meriç, Gökhan; Pündük, Zekine; Akseki, Devrim; Atik, Aziz; Sargın, Serdar

doi:10.1016/j.aott.2019.01.004

Cited by 4 publications

(1 citation statement)

References 24 publications

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“…35,40 ACL reconstruction is often recommended to achieve knee stability, particularly for young patients with a high activity level and those who cannot adjust to instability. 7,49,89 Arthroscopic ACL reconstruction is widely accepted as the treatment of choice to address this problem.…”

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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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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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Do final rehabilitation volumes influence function after anterior cross ligament reconstruction? A pilot study

et al. 2023

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Introduction Rupture of the anterior cruciate ligament (ACL) is one of the frequent traumatic injuries of the knee joint complex, and the isokinetic dynamometer is essential to assess and measure its joint function. Objective To analyze the volume of physical therapy treatment using the same protocol with different duration in patients undergoing ACL reconstruction. Methods This is a prospective observational cohort study. The sample consisted of 13 adult male individuals who underwent ACL reconstruction surgery. Participants were divided into two groups: accelerated treatment (AC) and non-accelerated treatment (NAC). Participants underwent a standardized protocol of post-reconstruction physio-therapy, starting in the immediate postoperative period. The AC group performed the treatment three times a week, with a duration of 4 hours each session for 6 months, while the NAC performed twice a week with duration of two hours each session for eight months. Results The groups showed the same behavior during the post-reconstruction treatment periods, showing that regardless of time, the results were beneficial at the end of the treatment. However, in the accelerated protocol, the injured limb showed a significant difference for extender peak torque (PTEXT) in the preoperative and 4-month postoperative period (230.5 vs 182.6), 4-month postoperative period and final (182.6 vs 242.1) in the AC group, while in the NAC group there was no significant difference between times in this same limb. Conclusion Greater volumes of weekly training characterized better results, showing that rehabilitation time is not a predictor of discharge, but rehabilitation time obtains good results for the variables.

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Effect of the TT and AM approaches in anterior cruciate ligament reconstruction on femoral tunnel and efficacy analysis

Liu

Zhang

Jiang

et al. 2023

Preprint

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Objective To compare the clinical efficacy, location and length of the femoral tunnel, graft angle, and radiographic findings between the transtibial tunnel (TT) approach and the anteromedial (AM) approach in the setting of anterior cruciate ligament (ACL) reconstructionMethods From September 2020 to December 2021, prospectively, 86 consecutive patients who met the criteria for ACL reconstruction were prospectively included in this study. The patients were randomly divided into two groups, TT group and am group, according to the computer-generated sequence. Finally, a total of 45 patients were included in the TT group and 41 patients in the AM group. All patients were assessed for knee clinical function using the Lysholm score, International Knee Documentation Committee (IKDC) score preoperatively, 6 months postoperatively, and at last follow-up. Anteroposterior and rotational stability of the knee were assessed by the Lachman test, axial shift test, and rotarod. The location of the femoral tunnel was evaluated within 1 week postoperatively using CT three-dimensional reconstruction combined with the Bernard quadrant method. Magnetic resonance imaging (MRI) MRI of the knee was performed 1 year after surgery to assess graft tone, morphology, and signal and was graded. The angle between the graft and the joint line was measured.Results Follow up ranged from 15 to 36 months with a mean (SD) of 23.76 ± 5.63. Both procedures resulted in satisfactory clinical outcomes after ACL reconstruction, and no patients in either group developed intra-articular infection, graft fracture, and joint stiffness during follow-up. At the last follow-up, the Lysholm, IKDC, Lachman and pivot shift tests were significantly improved (P < 0.05) compared to their preoperative values in both groups, and there was no significant difference between them (P > 0.05). The JGS and JGC angles in the TT group were significantly larger than those in the AM group (P < 0.05). CT three-dimensional reconstruction showed that the femoral tunnel center position of the AM approach was lower and deeper than that of the TT approach, and the difference was statistically significant (P < 0.05). Graft MRI grade after TT approach was superior to am approach (P < 0.05).Conclusion There were no significant differences between the AM approach and the TT approach in terms of knee clinical function and stability, but the femoral tunnels of the AM approach were located deeper and lower, and closer to the femoral anatomic foot print area of the anterior cruciate ligament. The TT approach was superior to the AM approach in postoperative radiographic grading of grafts.

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Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique

Cited by 4 publications

References 24 publications

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

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

Do final rehabilitation volumes influence function after anterior cross ligament reconstruction? A pilot study

Effect of the TT and AM approaches in anterior cruciate ligament reconstruction on femoral tunnel and efficacy analysis

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