In\u2013out versus out\u2013in technique for ACL reconstruction: a prospective clinical and radiological comparison

Edoardo Monaco,Mattia Fabbri,Andrea Redler,Raffaele Iorio,Jacopo Conteduca,Andrea Ferretti,Giuseppe Argento

doi:10.1007/s10195-017-0458-7

Edoardo Monaco, Mattia Fabbri + Show 5 more

Open Access

https://doi.org/10.1007/s10195-017-0458-7

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Abstract

BackgroundSeveral studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out–in (OI) technique.Materials and methodsForty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed.ResultsIn sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8.2° in group B (p = 0.009). Mean tunnel length was 40.3 ± 1.2 mm in group A and 32.9 ± 2.3 mm in group B (p = 0.01). No cases of posterior wall compromise were observed in any patient of either group. Clinical results were not significantly different between the two groups.ConclusionsThe OI technique provides greater obliquity of the femoral tunnel in coronal plane, along with satisfactory length of the tunnel and lack of posterior wall compromise.Level of evidenceII, prospective study.

Highlights

Many studies have reported good results in the short term after anterior cruciate ligament (ACL) reconstruction, some concerns still remain
Materials and methods Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique
The most important finding of this study is that a significant difference in femoral tunnel obliquity in the coronal plane was found when comparing the TT technique with the OI technique

Summary

Introduction

Many studies have reported good results in the short term after anterior cruciate ligament (ACL) reconstruction, some concerns still remain. Longterm studies, not including recent knowledge on anatomical femoral tunnel placement through the transportal (TP) technique, have reported high incidence of joint degeneration (as much as 52–56 % at 12–13 years after surgery) [1, 2], and an estimated 8–10 % of reconstructions result in recurrent instability and in graft failure. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out–in (OI) technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed. Results In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). No cases of posterior wall compromise were observed in any Keywords ACL Á Femoral tunnel Á Transtibial Á Out–in technique

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