Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Guglielmetti, Luiz Gabriel Betoni; Cury, Ricardo de Paula Leite; Oliveira, Victor Marques de; Camargo, Osmar Pedro Arbix de; Severino, Fabrício Roberto; Severino, Nilson Roberto; Fucs, Patrícia Maria de Moraes Barros

doi:10.1590/1517-869220162205159722

Cited by 3 publications

(11 citation statements)

References 26 publications

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“…In total, 4 studies analyzed the use of drilling techniques and their association with the risk of revision 15,17,24,71 and complications. 6,17,45 No differences in revision and complication rates were reported between both groups.…”

Section: Discussionmentioning

confidence: 99%

“…Among the 25 clinical studies, ** † † 4 (16% of all clinical studies) reported the incidence of revision. 16,17,24,71 The overall revision rate was 5.9% (442/7498 patients) in the AM group and 6.2% (94/1508 patients) in the TT group. Metaanalysis revealed no significant differences between the groups (n ¼ 9006; OR, 1.05 [95% CI, 0.76-1.45]; P ¼ .76) (Figure 5).…”

Section: Revisionsmentioning

confidence: 97%

“…Among the 25 clinical studies, 12 ** (48%) used the Lachman test as a benchmark to examine postoperative ACL sagittal laxity grade, and 13 studies † † (including the 12 studies that performed the Lachman test) used the pivotshift test to examine rotational stability of the knee at the final follow-up (Supplemental Table S3). Of the 25 clinical studies, 9 3,17,21,24,28,37,49,51,87 (36% of all clinical studies) described KT-1000 arthrometer results (Figure 2C and Supplemental Table S3). Based on these studies, the maximum manual displacement was 2.27 mm in the TT group and 1.54 mm in the AM group.…”

Section: Physical Examinations: Stabilitymentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Revisionsmentioning

confidence: 97%

Section: Physical Examinations: Stabilitymentioning

confidence: 99%

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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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“…Radiological Outcomes. Independently drilled tunnels were significantly shorter (6 RCTs 14,16,34,37,39,51 : MD, 8.72; P ¼ .001) and were placed closer to the native ACL footprint. These results were strengthened by the sensitivity analysis excluding the studies of Han et al 17 and Hussin et al, 23 which used a modified TT technique (Supplemental Figure S5).…”

Section: Outcomes Of Independent Versus Tt Drillingmentioning

confidence: 94%

“…Subanalyses evaluating the best technique among the different independent drilling approaches showed that the AM portal technique had the highest Lysholm score (11 RCTs b : MD, 0.68; P ¼ .001) and Tegner score (6 RCTs 6,13,17,35,39,51 : MD, 0.27; P ¼ .004) versus the TT approach, while statistical significance was not reached with the IKDC subjective (8 RCTs 6,13,16,17,22,23,34,51 AM portal technique was seen for the results of both the Lachman and pivot-shift tests (P ¼ .08 and .09, respectively). The sensitivity analysis excluding the 2 RCTs 17,23 with a modified TT technique confirmed all the previous differences, and both the Lachman and pivot-shift tests reached statistical significance in favor of the AM portal technique (P ¼ .03 and .04, respectively).…”

Section: Outcomes Of Different Independent Drilling Techniquesmentioning

confidence: 99%

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

Cuzzolin

Previtali

Delcogliano

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Anterior cruciate ligament (ACL) reconstruction can be performed with different techniques for independent and transtibial (TT) drilling of femoral tunnels, but there is still no consensus on which approach leads to the best outcome. Purpose: To assess whether the independent or TT drilling approach for ACL reconstruction leads to the best functional outcomes. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic literature search was conducted on July 1, 2020, using the PubMed, Web of Science, Cochrane Library, and Scopus databases. The influence of different femoral drilling techniques was analyzed through a meta-analysis in terms of patient-reported outcome measure scores, risk of complications, range of motion limitations, graft failure, and differential laxity. Subanalyses were performed to compare the different independent drilling techniques considered. Linear metaregression was performed to evaluate if the year of study publication influenced the results. The risk of bias and quality of evidence were assessed following the Cochrane guidelines. Results: A total of 22 randomized controlled trials including 1658 patients were included in the meta-analysis. Both International Knee Documentation Committee (IKDC) subjective score and Lysholm score were higher with the independent drilling approach (mean difference [MD], 1.24 [ P = .02] and 0.55 [ P = .005], respectively). No difference was documented in terms of the risk of reinjury, but independent drilling led to reduced KT-1000 arthrometer–assessed anterior tibial translation (MD, 0.23; P = .01) and a higher probability of a negative postoperative pivot-shift test finding (risk ratio, 1.13; P = .04). There were no significant differences in IKDC objective or Tegner scores. A P value of .07 was found for the association between the year of the study and IKDC objective scores. Conclusion: Independent femoral tunnel drilling provided better results than the TT approach, although the difference was not clinically significant. No difference was observed in the risk of reinjury. Increasingly better results were seen among surgical procedures performed in more recent years. Among the independent drilling options, the anteromedial portal technique seemed to provide the most favorable outcomes. The lack of clinically significant differences and the promising outcomes reported with new modified TT techniques suggest the importance of correct placement, rather than the tunnel drilling approach, to optimize the results of ACL reconstruction.

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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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Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Cited by 3 publications

References 26 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

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

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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