2017 ISAKOS Biennial Congress ePoster #1166

 

Modified Transtibial Vs Transportal Technique In Single Band Acl Reconstruction. Tomografic Comparison Of Positioning Femoral Tunnel

Horacio F. Rivarola-Etcheto, MD, Buenos Aires ARGENTINA
Emiliano Luis Alvarez Salinas, MD, Corrientes, CABA ARGENTINA
Cristian Carlos Collazo Blanchod, MD, Tigre, Buenos Aires ARGENTINA
Carlos Maria Autorino, Buenos Aires ARGENTINA
Marcos Palanconi, MD, Pilar, Buenos Aires ARGENTINA
Jesuan Zordan, MD, Rosario, SANTA FE ARGENTINA
Gonzalo Escobar, MD, Buenos Aires, PILAR ARGENTINA

Hospital Universitario Austral, Pilar, Buenos Aires, ARGENTINA

FDA Status Cleared

Summary

There is controversial information regards the anatomic localization of the femoral tunnel achieved through the modified transtibial technique.

Abstract

There are several studies reported in the literature that have compared conventional transtibial technique to anteromedial transportal technique (AM) for ACL single bundle reconstruction. Actually, there is controversial information regards the anatomic localization of the femoral tunnel achieved through the modified transtibial technique, and it is not known if this anatomical position can be performed in a similar fashion through the Trans- AM technique. The aim of this study is to determine whether it is possible to achieves a similar anatomical placement of the femoral tunnel with a modified transtibial ACL single bundle reconstruction tecnique compared to anteromedial transportal technique. Results were evaluated by tomographic comparisons between patients from both groups. METHODS: 36 patients (36 knees) who were candidates for an ACL single bundle reconstruction with patellar bone graft were included in the study. Patients were randomly allocated using a computerized sequence into two groups. 18 patients were assigned each group (modified transtibial vs AM transportal technique). Surgery was performed by the same surgical team in both groups. Femoral tunnel quadrant placement, oblicuity in the coronal and sagittal planes and diameter of the femoral tunnel were assesed tomographically for both groups, and statistical comparison between groups was realized. RESULTS: Average distance measured from posterior edge of the condyle to the femoral tunnel ( measured as a proportion respect to the T line) was similar in both groups ( Group I : 32.7 % +- 5.1% ; Group 2: 32.4 % +-4.4% , p = 0.85). Average distance measured from the Blumensaat line to the femoral tunnel (measured as a proportion respect to the H line) was similar in both groups ( Group I: 28.5% 4.49 % Group II , 31.5% of 4.83% p = 0.06). Average angulation values of the femoral tunnel in the coronal plane were lower in Group I than in Group II (Group I = 34.8 ° range 32.7 ° - 38.6 ° and 41.2 ° range Group II 36.7 ° - 43.1 ° P = 0.0016 ). Average angulation values of the femoral tunnel in the sagittal plane were similar in both groups (Group I 40.2 ° range 38.4 ° - 43.4 ° ; Group II 38 1 ° range 36.6 ° - 40.2 ° p = 0.17).. The average diameter of the femoral tunnel was significantly higher in group I than in Group II (Group I 11 mm 0.84 mm and 10.2 mm Group II 0.65mm p = 0.007)

Discussion And Conclusion

The modified transtibial technique for single bundle ACL reconstruction has proved to be suitable to reproduce the anatomic placement of the femoral tunnel compared to the transportal AM technique.