Comparison of clinical results, second look arthroscopic findings, and magnetic resonance imaging findings, between the transportal and outside-in techniques after double bundle anatomic anterior cruciate ligament reconstruction: A prospective randomized controlled trial with a minimum 2-year follow-up

Abstract

Introduction Although image analysis has shown that the outside-in (OI) technique is associated with different femoral tunnel geometry than the transportal (TP) technique in anatomic anterior cruciate ligament (ACL) reconstruction, it is not known whether clinical results differ between the two techniques. We aimed to compare clinical results, second-look arthroscopic findings, and magnetic resonance imaging (MRI) findings between the TP and OI techniques in anatomic double-bundle (DB) ACL reconstruction. Methods From November 2010 to March 2013, 128 cases were enrolled in this study and were randomly assigned to either the TP group (64 cases) or the OI group (64 cases), and DB ACL reconstructions were performed. At the minimum 2-year follow-up (34.9 ± 10.9 months), 111 patients (86.7 %) were evaluated with multiple clinical scores and stability tests. Ninety-three knees were evaluated for graft continuity, graft tension, and synovialization by using second-look arthroscopy. Seventy-eight knees were evaluated on MRI for graft continuity, femoral graft tunnel healing, and graft signal/noise quotient (SNQ). Results There were no significant differences between the two groups in terms of clinical evaluation, with the exception of postoperative functional test of International Knee Documentation Committee (IKDC) objective score. The ratio of grade A and B on the functional test of the objective IKDC score was significantly larger for the OI group than the TP group (P = 0.005). The second-look arthroscopic findings were not significantly different between the two groups in either bundle (P > 0.05). In addition, MRI findings did not differ significantly between the two groups (P > 0.05). Conclusion With the exception of the functional test of IKDC objective score, clinical results, second-look arthroscopic findings, and MRI findings did not differ significantly between the OI and TP techniques for anatomic ACL reconstruction.