2019 ISAKOS Biennial Congress ePoster #766

Prospective Comparative Study of Clinical, Arthroscopic, and Radiologic Results between the Transportal and Outside-In Techniques for Double-Bundle Anatomic Anterior Cruciate Ligament Reconstruction

Jae Gyoon Kim, MD, PhD, Prof., Ansan, Gyeonggi KOREA, REPUBLIC OF
Seung-Hoon Kang, MD, Changwon-Si, Gyeongsangnam-do KOREA, REPUBLIC OF
Jun-Ho Kim, MD, Seoul KOREA, REPUBLIC OF
Chae-Ouk Lim, MD, Cheong-Ju KOREA, REPUBLIC OF
Joon Ho Wang, MD, PhD, Seoul KOREA, REPUBLIC OF
Samsung Medical Center, Seoul, KOREA, REPUBLIC OF

FDA Status Not Applicable

Summary

The clinical results did not differ significantly over a minimum 2-year follow-up between the TP and OI techniques in anatomic DB ACL reconstruction. In addition, second-look arthroscopic findings and MRI findings did not differ between the two techniques, either, although femoral tunnel geometry was significantly different between the

Abstract

Objectives: Although the femoral tunnel geometries were different between the outside-in (OI) technique and the transportal (TP) technique after anatomic anterior cruciate ligament (ACL) reconstruction in many previous imaging studies, it is not known whether clinical results differ between the two techniques. We aimed to compare clinical results, second-look arthroscopic findings, and magnetic resonance imaging (MRI) findings between the TP and OI techniques in anatomic double-bundle (DB) ACL reconstruction.

Methods

From November 2010 to March 2013, 128 cases were enrolled in this study and were randomly assigned to either the TP group (64 cases) or the OI group (64 cases), and anatomic DB ACL reconstructions were performed (Fig 1). At the minimum 2-year follow-up (34.9 ± 10.9 months), 111 patients (86.7%) were evaluated with multiple clinical scores, stability tests, and complication rates. Ninety-three knees (72.6%) were evaluated for graft continuity, tension, and synovialization by using second-look arthroscopy (Fig 2). Seventy-eight knees (60.9%) were evaluated on MRI for graft continuity, femoral graft tunnel healing, and graft signal/noise quotient (SNQ) (Fig 3).

Results

The ratio of grade A and B on the functional test of the objective IKDC score was significantly larger for the OI group than the TP group (P = .005). However, the two groups did not differ significantly with regards to the other subgroup of IKDC objective score, Lachman test, pivot shift test, KT-2000 arthrometer results, Tegner activity scale, and IKDC subjective score preoperatively or at the final follow-up (all P > 0.05) (Table 1). During the follow-up period, re-rupture of the graft occurred in 10 cases and infection occurred in 1 case (P=0.50). Complications related to suspensory fixation devices occurred in 9 cases (P = 0.52). The second-look arthroscopic findings were not significantly different between the two groups in either bundle in terms of graft continuity, tension, and synovialization (P > 0.05) (Table 2). In the TP group, 27 cases (61.4%) showed no tear, and in the OI group, 31 cases (63.3%) showed no tear in both the AM and PL grafts. In addition, MRI findings did not differ significantly between the two groups in terms of graft continuity, femoral tunnel graft healing (P>0.05). Although the mean SNQ values for the ACL graft were consistently higher for the OI group than the TP group in both the AM and PL grafts, these differences were not statistically significant (P > 0.05) (Table 3).

Conclusions

With the exception of the functional test of IKDC objective score, clinical results did not differ significantly over a minimum 2-year follow-up between the TP and OI techniques in anatomic DB ACL reconstruction. In addition, second-look arthroscopic findings and MRI findings did not differ between the two techniques, either, although femoral tunnel geometry was significantly different between the TP and OI techniques.
Keywords: Knee, Anterior cruciate ligament, Double-bundle, Reconstruction, Transportal, Outside-in

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