Clinical Comparison of Anteromedial versus Anterolateral Tibial Tunnel Direction for Transtibial Posterior Cruciate Ligament Reconstruction

Abstract

Background It has been suggested that transtibial posterior cruciate ligament reconstruction may be compromised by graft abrasion at the “killer turn,” where the graft emerges from the tibia. In 1998, one of the authors suggested that beginning the tibial tunnel anterolaterally rather than anteromedially would reduce the killer turn and possibly improve the results of posterior cruciate ligament reconstruction. Purpose This article is intended to present the clinical results of single-bundle transtibial posterior cruciate ligament reconstruction, comparing cases in which the tibial tunnel was begun anteromedially with cases in which the tunnel was begun anterolaterally. Study Design Cohort study; Level of evidence, 3. Methods The authors retrospectively studied 23 patients (group I) using the anteromedial tibial tunnel technique from April 1998 to August 2003 and 37 patients (group II) using the anterolateral tibial tunnel technique from February 1998 to August 2003. The average follow-up period was 58.6 months in group I and 56.9 months in group II. The minimum follow-up period was 24 months in each group. All revision cases and patients with general laxity were excluded. Results The mean side-to-side difference of posterior tibial translation by Telos stress radiography was 3.98 ± 1.27 mm (range, 1.80-7.80 mm) in group I and 2.87 ± 1.25 mm (range, 1.43-6.82 mm) in group II, which was a statistically significant difference (P < .01). The final mean Lysholm knee score was 88.6 ± 7.10 points (range, 77-98 points) in group I and 88.4 ± 6.44 points (range, 78-98 points) in group II, which was not a statistically significant difference (P = .4358). According to the final International Knee Documentation Committee (IKDC) evaluation in group I, 30.4% (7 of 23) were normal (A), 60.9% (14 of 23) were nearly normal (B), and 8.7% (2 of 23) were abnormal (C). In group II, 24.3% (9 of 37) were normal (A), 73.0% (27 of 37) were nearly normal (B), and 2.7% (1 of 37) were abnormal (C) (P = .467). With respect to the mean side-to-side difference of range of motion, there was no statistically significant difference (P = .1697). The mean was 4.7° ± 2.38° (range, 2°-10°) in group I and 4.0° ± 1.73° (range, 0°-8°) in group II. Conclusion The anterolateral tibial tunnel technique is preferred to the anteromedial technique in terms of the objective results; however, clinical results as judged by Lysholm and IKDC scores are not significantly correlated to these results.