Does the anteromedial portal provide clinical superiority compared to the transtibial portal in anterior cruciate ligament reconstruction in nonprofessional athletes in short-term follow-up?

Yıl 2015, Cilt: 49 Sayı: 5, 483 - , 24.09.2015

Zeki Tasdemir , Deniz Gulabi Safiye Tokgoz Ozal Fevzi Saglam Nurzat Elmalı

Öz

Objective: Two drilling techniques of the femoral tunnel are commonly used in anterior cruciate ligament (ACL) reconstruction: through the transtibial (TT) portal or through the anteromedial (AM) portal. The aim of the present study is to investigate the radiological and clinical outcomes of arthroscopic single-bundle ACL reconstruction using AM and TT portal techniques for drilling the femoral tunnel in nonprofessional athletes.
Methods: A retrospective review was made of 44 nonprofessional athletes undergoing ACL reconstruction using AM and TT techniques between 2011–2013. The femoral tunnel clock position on axial magnetic resonance imaging (MRI) and the anterior-posterior position of the tibial tunnel on sagittal-cut MRI scan were measured. Radiological femoral tunnel and tibial tunnel anterior-posterior inclination angles were assessed. At final follow-up, the Lachman test and pivot-shift test were used in the evaluation of the anterior-posterior stability of the knee and the rotational stability of the knee. For clinical and functional evaluation, the modified Cincinnati knee grading system, Lysholm knee scoring scale, and International Knee Documentation Committee (IKDC) form were used.
Results: No statistically significant difference was determined between the groups in terms of patient age, follow-up period, gender, and affected side distribution. There were 6 outliers in the TT group due to the clock face position. The mean femoral tunnel inclination angle was 31.07°±8.44° in the AM group and 19.02°±8.93° in the TT group. The tibial tunnel inclination angle was 21.08°±5.42° in the TT group and 16.58°±7.02° in the AM group. A statistically significant difference was determined between the 2 groups. No statistically significant difference was observed between the 2 groups in terms of Lachman test, pivot-shift test, Lysholm score, IKDC score, and modified Cincinnati score results.
Conclusion: The AM technique has no clinical superiority compared to the TT technique in ACL reconstruction in nonprofessional athletes.

Anahtar Kelimeler

Anterior cruciate ligament; reconstruction; anteromedial portal; transtibial portal.

Kaynakça

• Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, et al. Nonanatomic tunnel position in tradi- tional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 2010;92:1427–31.
• Lee JK, Lee S, Seong SC, Lee MC. Anatomic single- bundle ACL reconstruction is possible with use of the modified transtibial technique: a comparison with the an- teromedial transportal technique. J Bone Joint Surg Am 2014;96:664–72.
• Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor Award paper. Arthroscopy 2003;19:297–304.
• Scopp JM, Jasper LE, Belkoff SM, Moorman CT 3rd. The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 2004;20:294–9.
• Shafizadeh S, Balke M, Kelz S, Hoeher J, Banerjee M. Low inter- and intraobserver variability allows for reliable tun- nel measurement in ACL reconstruction using the quad- rant method. Arch Orthop Trauma Surg 2014;134:529– 36.
• Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koe- bke J, Schneider T. Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 2009;17:220–7.
• Strauss EJ, Barker JU, McGill K, Cole BJ, Bach BR Jr, Verma NN. Can anatomic femoral tunnel placement be achieved using a transtibial technique for hamstring ante- rior cruciate ligament reconstruction? Am J Sports Med 2011;39:1263–9.
• Bottoni CR. Anterior cruciate ligament femoral tun- nel creation by use of anteromedial portal. Arthroscopy 2008;24:1319.
• Harner CD, Honkamp NJ, Ranawat AS. Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy 2008;24:113–5.
• Azboy I, Demirtaş A, Gem M, Kıran S, Alemdar C, Bulut M. A comparison of the anteromedial and transtibial drill- ing technique in ACL reconstruction after a short-term follow-up. Arch Orthop Trauma Surg 2014;134:963–9.
• Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, et al. Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Ar- throscopy 2011;27:380–90.
• Piasecki DP, Bach BR Jr, Espinoza Orias AA, Verma NN. Anterior cruciate ligament reconstruction: can anatomic femoral placement be achieved with a transtibial tech- nique? Am J Sports Med 2011;39:1306–15.
• Robert HE, Bouguennec N, Vogeli D, Berton E, Bowen M. Coverage of the anterior cruciate ligament femoral footprint using 3 different approaches in single-bundle re- construction: a cadaveric study analyzed by 3-dimensional computed tomography. Am J Sports Med 2013;41:2375– 83.
• Morgan CD, Kalman VR, Grawl DM. Definitive land- marks for reproducible tibial tunnel placement in an- terior cruciate ligament reconstruction. Arthroscopy 1995;11:275–88.
• Rue JP, Lewis PB, Parameswaran AD, Bach BR Jr. Single- bundle anterior cruciate ligament reconstruction: tech- nique overview and comprehensive review of results. J Bone Joint Surg Am 2008;90 Suppl 4:67–74.
• Amis AA, Jakob RP. Anterior cruciate ligament graft posi- tioning, tensioning and twisting. Knee Surg Sports Trau- matol Arthrosc 1998;6 Suppl 1:2–12.
• Abebe ES, Moorman CT 3rd, Dziedzic TS, Spritzer CE, Cothran RL, Taylor DC, et al. Femoral tunnel placement during anterior cruciate ligament reconstruction: an in vivo imaging analysis comparing transtibial and 2-incision tibial tunnel-independent techniques. Am J Sports Med 2009;37:1904–11.
• Arnold MP, Kooloos J, van Kampen A. Single-incision technique misses the anatomical femoral anterior cruci- ate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 2001;9:194–9.
• Gadikota HR, Sim JA, Hosseini A, Gill TJ, Li G. The re- lationship between femoral tunnels created by the trans- tibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint. Am J Sports Med 2012;40:882–8.
• Larson AI, Bullock DP, Pevny T. Comparison of 4 femo- ral tunnel drilling techniques in anterior cruciate ligament reconstruction. Arthroscopy 2012;28:972–9.
• Miller MD, Gerdeman AC, Miller CD, Hart JM, Gaskin CM, Golish SR, et al. The effects of extra-articular start- ing point and transtibial femoral drilling on the intra-ar- ticular aperture of the tibial tunnel in ACL reconstruction. Am J Sports Med 2010;38:707–12.
• Yau WP, Fok AW, Yee DK. Tunnel positions in transport- al versus transtibial anterior cruciate ligament reconstruc- tion: a case-control magnetic resonance imaging study. Arthroscopy 2013;29:1047–52.
• Chhabra A, Diduch DR, Blessey PB, Miller MD. Recreat- ing an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks. Arthroscopy 2004;20:328–30.
• Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoell- ner TM. The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 2001;29:567–74.
• Heming JF, Rand J, Steiner ME. Anatomical limitations of transtibial drilling in anterior cruciate ligament recon- struction. Am J Sports Med 2007;35:1708–15.
• Zhang Q, Zhang S, Li R, Liu Y, Cao X. Comparison of two methods of femoral tunnel preparation in single-bun- dle anterior cruciate ligament reconstruction: a prospec- tive randomized study. Acta Cir Bras 2012;27:572–6.
• Riboh JC, Hasselblad V, Godin JA, Mather RC 3rd. Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression. Am J Sports Med 2013;41:2693–702.