2015 ISAKOS Biennial Congress ePoster #1318
Modified Transtibial Versus Anteromedial Portal Technique in Anatomical Single Bundle ACL Reconstruction: Comparisons of Femoral Tunnel Position and Clinical Results
Sung-Do Cho, MD, PhD, Ulsan KOREA, REPUBLIC OF
Yoon-Seok Youm, MD, Prof., Ulsan KOREA, REPUBLIC OF
Hye Yong Cho, MD, Ulsan KOREA, REPUBLIC OF
University of Ulsan College of Medicine, Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan, KOREA
FDA Status Not Applicable
Summary: Our modified transtibial technique(creating a femoral tunnel with varus and internal rotation of the tibia as well as modification of the tibial tunnel orientation) in the SB ACL reconstruction showed good clinical results and anatomic placement of the femoral tunnel similar with those of AM portal technique.
Although several studies have compared a conventional transtibial technique with an anteromedial (AM) portal technique for single bundle (SB) anterior cruciate ligament (ACL) reconstruction, to our knowledge, no study to date has investigated whether use of the modified transtibial technique results in the femoral tunnel being in a similar anatomic position and similar clinical outcomes with those of the AM portal technique.
To compare the clinical outcomes and femoral tunnel position of SB ACL reconstruction using a modified transtibial technique(creating a femoral tunnel with varus and internal rotation of the tibia as well as modification of the tibial tunnel orientation) with those of SB ACL reconstruction using an AM portal technique.
A total of 40 patients (40 knees) who received arthroscopic SB ACL reconstructions were included in this study. Patients were randomized using a computer-generated sequence into 2 groups: 20 patients by modified transtibial technique (group I) and 20 patients by AM portal technique (group II). Clinical evaluations included 2000 International Knee Documentation Committee (IKDC) subjective knee score, Lysholm knee score, Tegner activity scale, Lachman test, pivot shift test, 2000 IKDC knee examination and KT-1000 arthrometer measurement. Three-dimensional (3D) CT images were analyzed according to the quadrant method and the obliquity of the femoral tunnels in the coronal and sagittal planes and the diameter of the tunnel orifice were measured.
All clinical parameters improved significantly after SB ACL reconstruction, with no between group differences. The mean distances of femoral tunnel center locations from the posterior condylar surface (0.8% differences, p=0.167) and from Blumensaat’s line (2.1% differences, p=0.067) were similar in groups I and II. The mean coronal obliquity of the femoral tunnel was significantly lower in group I than in group II (42.5° ± 6.1° vs. 49.3° ± 7.2°, p=0.001), but the mean sagittal obliquity was similar (41.9° ± 6.1° vs. 43.3° ± 5.4°, p=0.303). The mean area of the tunnel orifice was significantly greater in group I than in group II (11.6 ± 1.4 mm x 9.2 ± 1.6 mm vs. 10.3 ± 1.1 mm x 9.1 ± 1.4 mm, p=0.013).
Our modified transtibial technique in the SB ACL reconstruction showed good clinical results and anatomic placement of the femoral tunnel similar with those of AM portal technique.