Conventional trans‑tibial versus anatomic medial portal technique for femoral tunnel preparation in anterior cruciate ligament reconstruction; comparison of clinical outcomes

Abstract

Aim: Method of femoral tunnel preparation in anterior cruciate ligament (ACL) reconstruction is controversial. In this study, we aimed to determine if there is any difference between the clinical outcomes of two most commonly used drilling techniques; which are conventional trans‑tibial (TT) drilling of femoral tunnel and anatomic preparation of femoral tunnel through medial portal (MP), in patients who underwent ACL reconstruction.

Material and Methods: One hundred and twenty‑nine male patients who underwent ACL reconstruction between 2010 and 2012 were included in the study. Single‑bundle reconstruction with a quadrupled autologous hamstring graft was performed in all patients. Femoral tunnel was drilled by the conventional TT technique in 58 patients (Group 1) and through MP in 71 patients (Group 2). Functional evaluation was made about 12 months postoperatively. Functional evaluation included the Lysholm Knee Scale, International Knee Documentation Committee Scoring (IKDC), and Tegner Activity Level Scale were used for assessment. The anteroposterior stability was assessed using KT‑1000 arthrometer and the pivot shift test for assessment of rotational stability.

Results: Interval between injury and surgery was similar between two groups (median 8.0 vs. 10 weeks, for TT vs. MP, respectively). One hundred twenty‑five patients attending the final follow‑up examination (96.8%) were evaluated. The results of Lysholm, IKDC, and Tegner scales were found to be similar. According to KT‑1000 arthrometer results, MP group revealed slightly better results than TT group. Regarding pivot shift, MP group showed significantly better stability than TT group (P < 0.001).

Conclusion: The anatomical single‑bundle femoral tunnel preparation in the reconstruction of the ACL seems as effective as the conventional technique in terms of functional stability in the midterm. The technique better preserved the rotational stability in non‑professional athletes.

Keywords: Anterior cruciate ligament reconstruction, arthroscopy, medial portal, trans‑tibial