MRI and functional assessment of triportal technique in arthroscopic anatomical single-bundle anterior cruciate ligament reconstruction

Abstract

BACKGROUND: Arthroscopic anterior cruciate ligament (ACL) reconstruction surgery is routinely performed using two standard portals; however imprecise portal placement leads to the most common surgical error that is associated with the imprecise placement, which is the non anatomical positioning anatomical positioning of the femoral tunnel because of improper visualization of the posterior aspect of the medial surface of lateral femoral condyle, due to inadequate visualization of the attachment area over the femur using the standard two portals. To decrease the incidence of this error, various other portals have been descried to improve the visualization. We propose the routine use of an accessory medial portal, in addition to the standard anterolateral and anteromedial portals, to enhance the visualization of the lateral wall and to improve the anatomic accuracy. The arthroscope can also be moved interchangeably throughout the portals during the procedure for improved viewing during specific steps. The routine use of this portal was assessed both clinically and radiologically in our study at the end of 1 year by functional scoring and magnetic resonance imaging (MRI) scan, wherein the accuracy of the femoral attachment and healing of the graft were checked. OBJECTIVES: To assess the functional and radiological results of the routine use of triportal technique in anatomical ACL reconstruction. MATERIALS AND METHODS: We conducted a prospective study on 20 patients who were assessed preoperatively and postoperatively at the end of 12 months using the International Knee Documentation Committee and Lysholm score, and the stability was checked with Lachman and pivot shift test. An MRI of the postoperative knee was performed after 12 months to assess the position of the graft, graft integrity, and healing. RESULTS: All the patients at the end of the study had an exceptional functional and clinical outcome,which was correlated on MRI showing a near-accurate placement of the femoral tunnel with acceptable inclination. All our patients showed excellent anteroposterior and rotational stability when assessed by IKDC and Lysholm score at the end of 1-year follow-up. CONCLUSION: This study shows that the routine use of the accessory anteromedial portal gives a good functional outcome with the near-accurate placement of femoral tunnel, which corresponds to the MRI findings obtained in our study.