Abstract
BackgroundA femoral bone tunnel in ACL reconstruction can be constructed from the outside in or from the inside out. When doing it inside out, the approach can be via the anteromedial (AM) portal or through the tibial bone tunnel. It has been suggested that better results might be expected by doing it anteromedially. Clinical results after femoral tunnel drilling via the AM or transtibial (TT) techniques in reconstruction of anterior cruciate ligament (ACL) are presented.MethodsThree hundred patients with ACL injuries were chosen for this study from previously collected data on ACL reconstructions. They were divided into two groups: 150 patients treated with AM drilling and 150 treated with TT drilling. In the AM group, the reconstructions were performed using a semitendinosus graft with the Tape Locking Screw (TLS™) technique (n = 87) or Retrobutton™ femoral and BioScrew™ tibial fixation with a semitendinosus-gracilis graft (n = 63). In the TT group, the fixation method used was Rigidfix™ femoral and Intrafix tibial fixation with a semitendinosus-gracilis graft. The evaluation methods were clinical examination, knee scores (Lysholm, Tegner and IKDC) and instrumented laxity measurements (KT-2000™). Our aim was to evaluate if there was better rotational stability and therefore better clinical results when using AM drilling compared to TT drilling.ResultsAfter excluding revision ACL reconstructions, there were 132 patients in the AM group and 133 in the TT group for evaluation. At the 2-year follow-up, there were 60 patients in the AM group (45.5%) and 58 in the TT group (43.6%). There were no statistically significant differences between the groups in any of the evaluation methods used.ConclusionBoth drilling techniques resulted in improved patient performance and satisfaction. We found no data supporting the hypothesis that the AM drilling technique provides better rotational stability to the knee.Trial registrationISRCTN registry with study ID ISRCTN16407730. Retrospectively registered Jan 9th 2020.
Highlights
A femoral bone tunnel in anterior cruciate ligament (ACL) reconstruction can be constructed from the outside in or from the inside out
Improvement was seen on the following tests: Tegner activity levels from preoperative 2 in the AM group and 3 in the TT group to 6 in both groups at the 2-year follow-up, and Lysholm preoperative scores from 73 in the AM group and 76 in the TT group to over 90 points in both groups at the 2-year follow-up
The International Knee Documentation Committee (IKDC) scores improved in both groups between the 1and 2-year follow-ups (Table 1 and Fig. 1)
Summary
A femoral bone tunnel in ACL reconstruction can be constructed from the outside in or from the inside out When doing it inside out, the approach can be via the anteromedial (AM) portal or through the tibial bone tunnel. Anteromedial (AM) drilling is done from a low anteromedial portal and has been said to provide better rotational stability to the knee by creating a more oblique femoral tunnel positioning [2]. This drilling technique is thought to better mimic the anatomical femoral insertion of the anterior cruciate ligament
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