Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation

Abstract

ObjectiveTo compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL) reconstruction using a single band.MethodsA prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients) or two incisions (group 2: 20 patients). The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm) were evaluated.ResultsThe positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p < 0.05). The positioning of the femoral tunnel on the lateral radiograph, expressed as a mean percentage relative to the anterior border of Blumensaat's line, was 68.4% in group 1 and 58% in group 2 (p < 0.05). The mean inclination of the graft was 19° in group 1 and 27.2° in group 2 (p < 0.05). The mean graft isometricity was 0.96 mm in group 1 and 1.33 mm in group 2 (p > 0.05). Group 2 had better results from the pivot-shift maneuver (p < 0.05).ConclusionThe technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.

Independent Versus Transtibial Drilling in Anterior Cruciate Ligament Reconstruction: A Meta-analysis With Meta-regression

“…Of the 5089 records extracted, 22 RCTs were included in the quantitative synthesis. Considering the different treatment arms, the TT approach was compared in 13 studies with the AM portal technique, ¶ 6 with the outside-in technique, 14 , 32 , 37 , 40 , 43 , 50 and 3 with the all-inside technique. 4 , 41 , 45 Moreover, 15 of the studies selected a hamstring tendon graft, ＃ 5 opted for a bone–patellar tendon–bone graft, 13 , 14 , 40 , 41 , 43 while 3 chose a frozen Achilles tendon allograft.…”

A meta‑analysis on anterior cruciate ligament reconstruction: Is modified transtibial technique inferior to independent drilling techniques?

“…The IKDC objective score was analyzed as a dichotomous variable ( 16 , 19 – 22 ) and the OR value was defined as ‘(number of patients rated A and B)/(number of patients rated C and D)’. There were 305 patients in five studies included in the comparison between the sTT and the ID techniques.…”

“…An analysis on the Lachman test results as dichotomous variables was conducted ( 14 , 16 , 19 , 22 ) and the OR value was defined as ‘(number of patients with positive test results)/(number of patients with negative test results)’. There were 159 patients in four studies included in the comparison between the sTT and the ID techniques.…”

“…The Tegner activity scale was analyzed as a continuous variable ( 14 , 19 , 22 ), in three articles where 98 patients were included in the comparison between the sTT and the ID techniques. According to the study results, no statistically significant differences were seen in Tegner activity scale between the sTT and the ID group [SMD=−0.22, 95% CI (−1.16, 0.73), P=0.66].…”

“…In comparison between the sTT and ID techniques, when the article contributed by Matassi et al ( 21 ) was removed from the analysis of IKDC subjective score, the data heterogeneity significantly dropped (P=0.97, I 2 =0%) and significant statistical differences between the two groups were observed [SMD=−0.30, 95% CI (−0.57, −0.03), P=0.03]; as to Lachman test, when Yanasse's et al ( 22 ) study was excluded, the analytical results showed statistically significant differences between the two groups [OR=2.39, 95% CI (0.90, 6.35), P=0.08], with the ID group having less positive results and without data heterogeneity (P=0.35, I 2 =0%); in terms of pivot-shift test, the analytical results suggested significant statistical differences after the article of Xu et al ( 24 ) was excluded [OR=2.75, 95% CI (1.64, 4,63), P=0.0001] and meanwhile, the data heterogeneity was significantly reduced (P=0.63, I 2 =0%); when the study of Lanzetti's et al ( 14 ) was excluded from the analysis on Tegner activity scale, there remained no statistically significant differences between the two groups [SMD=0.27, 95% CI (−0.27, 0.80), P=0.33] and yet the data heterogeneity was decreased significantly (P=0.57, I 2 =0%) ( Table II ).…”