Short term clinical results of single bundle ACL reconstruction, with a quadruple autologous hamstring graft, modified transtibial versus anteriomedial portal approach for femoral tunnel

Anteriior cruciate ligament injuries are known to be the most common spots injuries, and ACL reconstruction is widely used because of the low success rate of convservative treatment. This study was aimed to compare the short-terma functional results of modifying transtibial and transportal technique for femoral tunnel drilling. This Retrospective comparative case control study included 76 patients with an isolated ACL tear, operated with ST tendon autograft ACL reconstruction by the same surgical tea. 36 patients operated with a modified transtibial approach and 40 patients with an antreomedial approach for femoral drilling. The results of the current study revealed that the mean age in the series was 26 years; the majority of patients were male, only 6 patient's asses again after two years of surgery, by instability tests and lysholm scores reveal no significant differences between two group regarding anterioposterior and rotatory instability, also comparable lysholm score results. The Study concluded that modified transtibial femoral drilling of the femoral tunnel in ACL reconstruction surgery is still useful and give comparable results as tranportal drilling (AU)

A comparative study of arthroscopic anterior cruciate ligament reconstruction via transtibial and transportal techniques / 中国修复重建外科杂志

Objective: To investigate the effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction via transtibial (TT) and transportal (TP) techniques after 10 years follow-up. Methods: A clinical data of 103 patients who underwent arthroscopic ACL reconstruction with a single bundle of autologous hamstring tendon between March 2006 and March 2009 was retrospectively analyzed, among which 57 patients were reconstructed with TT technique (TT group) and 46 patients were reconstructed with TP technique (TP group). There was no significant difference in gender, age, cause of injury, interval between injury and operation, preoperative pivot shift test, preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, and KT-2000 side-to-side difference (SSD) between the two groups ( P>0.05). At 10 years after operation, Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee; KT-2000 SSD was used to measure tibial anterior displacement; IKDC score and Lysholm score were used to evaluate knee function; MRI examination was performed to observe graft healing and measure coronal inclination angles of the tibia and femoral tunnels. The rate of return to sports was also calculated. Results: The incisions healed by first intention in the two groups, and no early complication occurred after operation. All patients were followed up 10-13 years, with an average of 11.5 years. During the follow-up period, there was no limitation of knee extension and flexion, no discomfort of donor site or graft failure in either group. MRI examination showed that the graft healed well. The IKDC score, Lysholm score, and KT-2000 SSD in the two groups were significantly improved after 10 years ( P0.05). There were significant differences in coronal inclination angles of femoral tunnel and tibial tunnel between the two groups ( P0.05). The rate of return to sports of patients was 61.40% (35/57) in TT group and 63.04% (29/46) in TP group, showing no significant difference between the two groups ( χ2=0.29, P=0.87). Conclusion: TT and TP techniques can both achieve good effectiveness in ACL reconstruction.

Direccion y longitud del tunel femoral en la plastia del ligamento cruzado anterior transportal. Influencia de la ubicacion del portal medial y las guias femorales / Direction and length of the femoral tunnel in anterior cruciate ligament reconstruction. Influence of anteromedial portal and femoral aimers

Introducción: Las técnicas transportales para la plastia del ligamento cruzado anterior (LCA) tienen desventajas con respecto a otras técnicas relacionadas a la dirección y longitud del túnel femoral. El objetivo principal del estudio es describir una técnica transportal anatómica vertical (TPA-V) para el fresado del túnel femoral utilizando una guía femoral con extremo punzante. El segundo objetivo es comparar la variabilidad radiográfica con una técnica transportal anatómica clásica (TPA-C) utilizando otras guías femorales. Material y Método: Se describe una nota técnica de fresado femoral TPA-V utilizando una guía femoral con extremo punzante. Se diseñó un estudio observacional retrospectivo que comparó dos formas de realizar el túnel femoral por portal medial durante la plastia del LCA. El grupo 1: técnica TPA-V con una guía femoral con extremo punzante. El grupo 2: técnica TPA-C con guía femoral transportal Arhrex o guía femoral transtibial universal de 7 mm. Se analizaron mediciones del túnel femoral tales como ubicación, inclinación coronal y longitud relativa. Resultados: El túnel femoral fue ubicado correctamente en ambos grupos. En el grupo 1, el túnel femoral fue más vertical y presentó una mayor longitud relativa con una diferencia significativa (p <0,0001). Conclusión: La utilización de una técnica TPA-V con una guía femoral con extremo punzante permite realizar un túnel femoral anatómico más vertical y largo en comparación con una técnica TPA-C. Significancia clínica: Un túnel femoral TPA-V podría disminuir el riesgo de complicaciones en pacientes que requieran una plastia del LCA. Nivel de evidencia: 4

Introduction: Anteromedial techniques for anterior cruciate ligament (ACL) reconstruction have disadvantages with respect to other related to the direction and length of the femoral tunnel. The main objective of this article is to present a vertical anatomical anteromedial technique (V-AAM) for drilling the femoral tunnel using a aimer with sharp end. The second objective is to compare the radiographic variability with a classic anatomical anteromedial technique (C-AAM) using other femoral aimers. Material and Methods: A V-AAM technique for drilling the femoral tunnel using a aimer with sharp end is described. A retrospective observational study comparing two forms of femoral tunnel placement was designed. Group 1: V-AAM technique with a sharp end aimer. Group 2: C-AAM technique with Arhrex medial portal aimer or universal transtibial femoral aimer. Femoral tunnel measurements such as location, coronal inclination and relative length were analyzed. Results: The femoral tunnel was located correctly in both groups. In group 1, the femoral tunnel was more vertical and had a higher relative length with a significant difference (p <0.0001). Conclusion: The use of a V-AAM technique with a sharp end aimer allows a more vertical and long anatomical femoral tunnel compared to a C-AAM technique. Clinical significance: A V-AAM femoral tunnel could reduce the risk of complications in patients requiring ACL reconstruction. Evidence Level: 4

Ligamento cruzado anterior. Reconstrucción transtibial vs. transportal. Evaluación radiológica de la posición del tunel femoral y tibial / Anterior cruciate ligament reconstruction. Transtibial vs. transportal technique. Radiological evaluation

Introducción: La tendencia actual en la cirugía de reconstrucción del LCA es intentar reproducir con la plástica, la huella anatómica original femoral y tibial. La realización de túneles independientes permitiría optimizar el punto de entrada en la huella femoral, que junto con la oblicuidad y el diámetro de la fresa, reproducirían con mayor certeza la anatomía. Objetivo: comparar con parámetros radiográficos objetivos la posición de los túneles femorales y tibiales, en dos grupos de pacientes operados con técnica transtibial y transportal anatómicas. Material y métodos: de diciembre del 2012 a diciembre del 2013, se evaluaron radiológicamente en forma prospectiva 59 pacientes con plástica primaria del LCA divididos en dos grupos, uno con técnica transtibial (TT), 19 pacientes y 40 pacientes con técnica transportal (TP). En el fémur, determinamos, el ángulo de inclinaciónn del túnel, el sitio de inserción con respecto a la línea de Blumensaat y la distancia transósea; en la tibia, la ubicación en porcentaje de la localización con respecto al platillo tibial en el frente y perfil y el ángulo del túnel tibial en el frente y en el perfil. Resultados: en el fémur: el ángulo de inclinación del túnel en el grupo (TP) fue de 45,92º, y en el (TT) de 24,53º, P 0,002; el porcentaje en la línea de Blumensaat en el (TP), fue de 20,95 y en (TT) de 20,74 con una p 0,681, y la distancia transósea en el (TP) fue de 3,43 cm y para el (TT) de 4,79 cm con una p< 0,000. En la tibia la distancia porcentual en el frente fue de 44,35 para (TP) y de 40,80 para TT con p de 0.076, y en el perfil fue de 28,70 para (TP) y de 34,53 para TT con una p 0,367. Finalmente, el ángulo del túnel tibial en el frente fue de 73,48 para el (TP) y de 62,81 para el (TT) con p 0,002, y para el perfil fue de 114,69 para (TP) y de 112,79 para (TT) con p de 0.427. Conclusión: con ambas técnicas es posible realizar un túnel tibial y femoral en posición óptima pero no iguales. La realización de túneles independientes permitiría colocar un túnel tibial más anterior y vertical mejorando la cobertura de la huella anatómica normal, y el túnel femoral por vía transportal nos permitiría obtener un mayor ángulo de inclinación y una menor distancia transósea, detalles técnicos que optimizarían la cobertura anatómica de esta huella. Nivel de evidencia: II. Tipo de estudio: prospectivo comparativo.

Introduction: The most recent advances in ACL reconstruction try to reproduce the anatomic femoral and tibial footprints as close as possible. Creating independent tunnels would allow the optimizacion of the entry point and the femoral tunnel obliquity, and together with an adequate reamer diameter, they would allreproduce with greater certainty the anatomy. Objective: to compare the radiographic parameters of the femoral and tibial tunnel positions in two groups of patients, one operated with a transtibial and other with transportal anatomic techniques. To compare radiographic parameters of a group of patients operates with a transtibial technique versus a group operated with a transportal one and define the the tunnel positions. Materials and methods: from December 2012 to December 2013, 59 patients with a primary ACL reconstruction divided in two groups, a trans tibial technique (TT), 19 patients, and an transportal one (TP) with 40 patients were prospectively evaluated with AP and lateral X-rays. The femoral tunnel angle, the insertion site with respect of the Blumensaat line, the trans osseous distance, the tibial tunnel position as a percentage of the tibial plateau in the AP and lateral views. Finally the tibial tunnel angle in the AP and Lateral views. Results: the femoral tunnel angle was in the TP group of 45,92º and in the TT one 24,53º, p 0,002. The insertion site percentage of the Blumensaat line was of 20,96 in TP and 20,74 in the TT, p 0,681.Trans osseous distance was in the TP of 3,43 cm and in the TT of 4,79 cm, p <0,000. The tibial tunnel position as a percentage in the AP tibial plateau was of 44,35 in TP and of 40,80 TT with a p of 0,076. The tibial tunnel position as a percentage of the lateral tibial plateau was of 28,70 in TP and 34,53 in TT with a p 0,367. Tibial tunnel angle in the AP was of 73,48º in TP and 62,81 in TT with a p of 0,002, and in the lateral plateau of 114,69º in TP and 112,79º in TT with a p of 0,427. Conclusion: it is possible to create tibial and femoral tunnel in optimal positions but not equal between both groups. Creating independent tunnels allow a more anterior and vertical tibial tunnel allowing a better coverage of the tibial footprint. A transportal femoral tunnel would allow a better inclination angle and a lesser trans-osseous distance, technical details that would allow a better coverage of the femoral footprint. Level of Evidence: II. Type of study: prospective comparative study.