Tunnel Positions in Transportal Versus Transtibial Anterior Cruciate Ligament Reconstruction: A Case-Control Magnetic Resonance Imaging Study

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

“…Our results are in line with other recent studies that indicate that the TT technique shows a tendency to place the tunnel more into the roof of the notch, leading to a more vertical position of the graft [14][15][16][17]. TP drilling allows positioning of the femoral tunnel independent of the tibial tunnel and thus potentially in a more anatomical position.…”

Comparisons of tunnel-graft angle and tunnel length and position between transtibial and transportal techniques in anterior cruciate ligament reconstruction

“…The transportal technique in ACL reconstruction has been recommended over the traditional transtibial technique for All values presented as mean (standard deviation) AP anteroposterior, ML mediolateral creating a more accurate anatomical femoral tunnel [4,9,11,12]. However, the transportal technique has some possible disadvantages [14][15][16].…”

“…Giron et al [9] showed that the standard transtibial technique in ACL reconstruction could not restore the anatomic femoral origin of the ACL despite some technical modifications. To address problems related to a vertical femoral tunnel, some surgeons have advocated performing independent drilling (transportal technique) through an anteromedial portal to place the femoral tunnel in the anatomical position instead of using the standard transtibial drilling technique [4,[10][11][12]. While some studies have reported that anteromedial portal drilling could place the femoral tunnel in the anatomical position better than transtibial drilling [10,12,13], other studies reported possible disadvantages, such as short tunnel length, posterior-wall blowout, neurovascular damage of the lateral side of the knee and partial graft rupture due to excessive stress [13][14][15][16].…”

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

“…Yau et al 12 examined the difference in the position of bone tunnels prepared by the transportal technique versus the TT technique using magnetic resonance imaging. The average clock position was 10:18 in the transportal group and 10:54 in the TT group.…”