Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique

Koutras, Georgios; Papadopoulos, Pericles; Terzidis, Ioannis; Gigis, Ioannis; Pappas, Evangelos

doi:10.1007/s00167-012-2323-9

Cited by 49 publications

(39 citation statements)

References 28 publications

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“…Despite significant differences in tunnel positioning, no differences in clinical outcome measures were observed between our groups. Some studies indicate that TP drilling of the femoral tunnel improves clinical outcome [23,24], while other studies do not report any obvious differences [25][26][27]. In our study, clinical outcome was assessed using subjective questionnaires, and not by objective clinical assessment of laxity, which may have moderated potential differences.…”

Section: Discussionmentioning

confidence: 72%

Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study

Clockaerts¹,

Haver²,

Verhaegen³

et al. 2016

The Knee

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Section: Discussionmentioning

confidence: 72%

Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study

Clockaerts¹,

Haver²,

Verhaegen³

et al. 2016

The Knee

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“…This agrees with some of the findings by Alentorn-Geli et al [4], who demonstrated no differences in Lysholm or Tegner scores; however, they did find improved International Knee Documentation Committee scores in those undergoing an AM portal-based reconstruction. Koutras et al [27] demonstrated no differences in Lysholm scores at 6 months in patients undergoing hamstring autograft when comparing TT versus AM groups using hamstring autograft. Although are results are in agreement with some of the findings in these studies, our study was not powered to detect significant differences in this regard.…”

Section: Discussionmentioning

confidence: 97%

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Considerable debate remains over which anterior cruciate ligament (ACL) reconstruction technique can best restore knee stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel; however, potential nonanatomic tunnel placement can produce a vertical graft, which although it would restore sagittal stability, it would not control rotational stability. To address this, some suggest that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial (AM) portal, but whether this results in a more anatomic footprint or in stability comparable to that of the intact contralateral knee still remains controversial. Questions/purposes (1) Does the AM technique achieve footprints closer to anatomic than the transtibial (TT) technique? (2) Does the AM technique result in stability equivalent to that of the intact contralateral knee? (3) Are there differences in patient-reported outcomes between the two techniques? Methods Twenty male patients who underwent a bonepatellar tendon-bone autograft were recruited for this study, 10 in the TT group and 10 in the AM group. Patients in each group were randomly selected from four surgeons at our institution with both groups demonstrating similar demographics. The type of procedure chosen for each patient was based on the preferred technique of the surgeon. Some surgeons exclusively used the TT technique, whereas other surgeons specifically used the AM technique. Surgeons had no input on which patients were chosen to participate in this study. Mean postoperative time was 13 ± 2.8 and 15 ± 3.2 months for the TT and AM groups, respectively. Patients were identified retrospectively as having either the TT or AM Technique from our institutional database. At followup, clinical outcome scores were gathered as well as the footprint placement and knee stability assessed. To assess the footprint placement and knee stability, three-dimensional surface models of the femur, tibia, and ACL were created from MRI scans. The femoral and tibial footprints of the ACL reconstruction as compared with the intact contralateral ACL were determined. In addition, the AP displacement and rotational displacement of the femur were determined. Lastly, as a secondary measurement of stability, KT-1000 measurements were obtained at the followup visit. An a priori sample size calculation indicated that with 2n = 20 patients, we could detect a difference of 1 mm with 80% power at p \ 0.05. A Welch two-sample t-test (p \ 0.05) was performed to determine differences in the footprint measurements, AP displacement, rotational displacement, and KT-1000 measurements between the TT and AM groups. We further used the confidence interval approach with 90% confidence intervals on the pairwise mean group differences using a Games-Howell post hoc test to assess equivalence between the TT and AM groups for the previously mentioned measures. Results The AM and TT techniques were the same in terms of footprint except in the distal...

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“…In a short-term study conducted by Koutras et al 17 , 51 patients were included and data were collected at 3 and 6 months after surgery. The AM approach group had better Lysholm scores at 3 months and better perfor-unclear whether this widening has a correlation with the clinical outcomes of ACL reconstruction.…”

Section: Clinical Studiesmentioning

confidence: 99%

Femoral tunnel drilling in anterior cruciate ligament reconstruction: Anteromedial or transtibial portal? Current review

Sedeek¹,

Andrew²

2013

Hard Tissue

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Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique

Abstract: Therapeutic study, Level II.

Cited by 49 publications

References 28 publications

Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study

Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Femoral tunnel drilling in anterior cruciate ligament reconstruction: Anteromedial or transtibial portal? Current review

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