Klinik Araştırma
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A comparison of clinical results of transtibial and transportal anatomical techniques in the arthroscopic reconstruction of anterior cruciate ligament

Yıl 2022, Cilt 3, Sayı 1, 18 - 23, 31.01.2022

Öz

Background: The present study aims to compare the clinical outcomes of patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction with Transtibial (TT) and Transportal Anatomical (TA) techniques with the diagnosis of ACL rupture.

Methods: A total of 56 patients who underwent arthroscopic ACL repair in the Orthopedics and Traumatology Clinic of Menemen State Hospital between 2015 and 2020 were included in the study. The mean age of the patients was 25 years, and follow-up period was 31 months. Of the patients, 53 were male, 3 were female, and 43 had ACL ruptures in the right knee and 13 in the left knee. ACL reconstruction was performed using the TT technique in 29 patients and the TA technique in 27 patients. Patients were evaluated using the Lysholm Assessment score, the Modified Cincinnati Rating System Questionnaire, the Tegner Activity Level Scale, and the International Knee Documentation Committee scoring.

Results: There was a significant difference in pre and postoperative controls (p<0.05) and while normal and near-normal results were obtained with the TT (89%) and TA (87%) techniques, there was no statistically significant difference between the two techniques when the postoperative data were compared (p>0.05).

Conclusions: In this study, there was no significant difference between the two techniques in terms of clinical outcome and patient satisfaction. Although there are studies in the literature showing that the TA technique is superior in terms of knee stability, good results are obtained with both techniques.

Kaynakça

  • 1. Woo SLY, Fox RJ, Sakane M, Livesay GA, Rudy TW, Fu FH. Biomechanics of the ACL: Measurements of in situ force in the ACL and knee kinematics. The Knee. 1998;5:267-288.
  • 2. Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH; Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006:982–92.
  • 3. Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 1999;27:143-56.
  • 4. Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence ofanterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 2007;35:1756-69.
  • 5. Ahn JH, Jeong HJ, Ko CS, Ko TS, Kim JH. Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg. 2013;5:26–35
  • 6. Shin YS, Ro KH, Lee JH, Lee DH. Location of the femoral tunnel aperture in single-bundle anterior cruciate ligament reconstruction: comparison of the transtibial, anteromedial portal, and outside-in techniques. Am J Sports Med. 2013;41:2533–9.
  • 7. Riboh JC, Hasselblad V, Godin JA, Mather RC III. Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and metaregression. Am J Sports Med. 2013;41:2693–702.
  • 8. Smith F, Rosenlund E, Aune A, MacLean J, and Hillis S. Subjective functional assessments and the return to competitive sport after anterior cruciate ligament reconstruction. Br J Sports Med. 2004;38: 279–284.
  • 9. Lee DYH , Karim SA, Chang HC. Return to sports after anterior cruciate ligament reconstruction - a review of patients with minimum 5-year follow-up. Ann Acad Med Singap. 2008;37:273-8.
  • 10. Jinzhong Zhao. Anatomical single-bundle transtibial anterior cruciate ligament reconstruction. Arthrosc Tech. 2020;29:1275-1282.
  • 11. Guglielmetti LG, Cury Rde P, de Oliveira VM, de Camargo OP, Severino NR, Fucs PM. Anterior cruciate ligament reconstruction: a new cortical suspension device for femoral fixation with transtibial and transportal techniques. J Orthop Surg Res. 2014;9:110.
  • 12. Alentorn-Geli E, Lajara F, Samitier G, Cugat R. The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18:1013–37.
  • 13. Yau WP, Fok AW, Yee DK. Tunnel positions in transportal versus transtibial anterior cruciate ligament reconstruction: a case-control magnetic resonance imaging study. Arthroscopy. 2013;29:1047–52.
  • 14. Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH. Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc. 2012;20:2200–7.
  • 15. Song EK, Kim SK, Lim HA, Seon JK. Comparisons of tunnel-graft angle and tunnel length and position between transtibial and transportal techniques in anterior cruciate ligament reconstruction. Int Orthop. 2014;38:2357–62.
  • 16. Mandal A, Shaw R, Biswas D, Basu A. Transportal versus transtibial drilling technique of creating femoral tunnel in arthroscopic anterior cruciate ligament reconstruction using hamstring tendon autograft. J Indian Med Assoc. 2012;110:773–5.
  • 17. Brown CH Jr, Spalding T, Robb C. Medial portal technique for singlebundle anatomical anterior cruciate ligament (ACL) reconstruction. Int Orthop. 2013;37:253–69.
  • 18. Haitao Chen, Kai Tie, Yongjian Qi, Bin Li, Biao Chen, Liaobin Chen. Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials. J Orthop Surg Res. 2017;12:167
  • 19. Azboy I, Demirtas A, Gem M, Kiran S, Alemdar C, Bulut M. A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up. Arch Orthop Trauma Surg. 2014;134:963–9.
  • 20. Tasdemir Z, Gulabi D, Saglam F, Tokgoz Ozal S, Elmali N. 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? Acta Orthop Traumatol Turc. 2015;49:483–491.
  • 21. Ozel O, Yucel B, Orman O, Demircay E, Mutlu S. Comparison of anteromedial and transtibial ACL reconstruction using expandable fixation. Orthopedics. 2017:1;40:532-537
  • 22. Sisk TD. Knee Injuries. In: Campbell’s Operative Orthopaedics, 1996;8:1487–732.
  • 23. Krause M, Freudenthaler F, Frosch KH, Achtnich A, Petersen W, Akoto R. Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture. Dtsch Arztebl Int. 2018;24;115:855-862
  • 24. Tashman S, Araki D. Effects of ACL reconstruction on in vivo, dynamic knee function. Clin Sports Med. 2013;32:47–59.
  • 25. Tie K, Chen L, Hu D, Wang H. The difference in clinical outcome of single-bundle anterior cruciate ligament reconstructions with and without remnant preservation: A meta-analysis. Knee. 2016;23:566–74.
  • 26. Kilinc BE, Kara A, Oc Y, Celik H, Camur S, Bilgin E. et al. Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A retrospective cohort study. Int J Surg. 2016;29:62–9
  • 27. Kyung HS, Baek SG, Lee BJ, Lee CH. Single-bundle anterior Cruciate ligament reconstruction with semitendinosus tendon using the PINNACL crosspin system: minimum 4-year follow-up. Knee Surg Relat Res. 2015;27:43–48
  • 28. Zhang Y, Xu C, Dong S, Shen P, Su W, Zhao J. Systemic review of anatomic single- versus double-bundle anterior cruciate ligament reconstruction: does femoral tunnel drilling technique matter? Arthroscopy. 2016;32:1887–904.
  • 29. Silva A, Sampaio R, Pinto E. ACL reconstruction: comparison between transtibial and anteromedial portal techniques. Knee Surg Sports Traumatol Arthrosc. 2012;20:896–903.
  • 30. Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, et al. Nonanatomic tunnel position in traditional transtibial single bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am. 2010;92:1427–31
  • 31. Hefzy MS, Grood ES, Noyes FR. Factors affecting the region of most isometric femoral attachments. Part II: The anterior cruciate ligament. Am J Sports Med. 1989;17:208-16.
  • 32. Silver AG, Kaar SG, Grisell MK, Reagan JM, Farrow LD. Comparison between rigid and flexible systems for drilling the femoral tunnel through an anteromedial portal in anterior cruciate ligament reconstruction. Arthroscopy. 2010;26:790-5
  • 33. Mirzatolooei F. Comparison of short term clinical outcomes between transtibial and transportal TransFix(R) femoral fixation in hamstring ACL reconstruction. Acta Orthop Traumatol Turc. 2012;46:361–366.
  • 34. Metso L, Nyrhinen KM, Bister V, Sandelin J, Harilainen A. Comparison of clinical results of anteromedial and transtibial femoral tunnel drilling in ACL reconstruction. BMC Musculoskeletal Disord. 2020;21:341.
  • 35. Jinzhong Zhao. Anatomical Single-Bundle Transtibial Anterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2020;29:1275-1282.
  • 36. Hatipoğlu MY, Bircan R, Özer H, Selek HY, Harput G, Baltacı YG. Radiographic assessment of bone tunnels after anterior cruciate ligament reconstruction: A comparison of hamstring tendon and bone-patellar tendon-bone autografting technique. Jt Dis Relat Surg 2021;32(1):122-128.

Yıl 2022, Cilt 3, Sayı 1, 18 - 23, 31.01.2022

Öz

Kaynakça

  • 1. Woo SLY, Fox RJ, Sakane M, Livesay GA, Rudy TW, Fu FH. Biomechanics of the ACL: Measurements of in situ force in the ACL and knee kinematics. The Knee. 1998;5:267-288.
  • 2. Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH; Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006:982–92.
  • 3. Gillquist J, Messner K. Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 1999;27:143-56.
  • 4. Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence ofanterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 2007;35:1756-69.
  • 5. Ahn JH, Jeong HJ, Ko CS, Ko TS, Kim JH. Three-dimensional reconstruction computed tomography evaluation of tunnel location during single-bundle anterior cruciate ligament reconstruction: a comparison of transtibial and 2-incision tibial tunnel-independent techniques. Clin Orthop Surg. 2013;5:26–35
  • 6. Shin YS, Ro KH, Lee JH, Lee DH. Location of the femoral tunnel aperture in single-bundle anterior cruciate ligament reconstruction: comparison of the transtibial, anteromedial portal, and outside-in techniques. Am J Sports Med. 2013;41:2533–9.
  • 7. Riboh JC, Hasselblad V, Godin JA, Mather RC III. Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and metaregression. Am J Sports Med. 2013;41:2693–702.
  • 8. Smith F, Rosenlund E, Aune A, MacLean J, and Hillis S. Subjective functional assessments and the return to competitive sport after anterior cruciate ligament reconstruction. Br J Sports Med. 2004;38: 279–284.
  • 9. Lee DYH , Karim SA, Chang HC. Return to sports after anterior cruciate ligament reconstruction - a review of patients with minimum 5-year follow-up. Ann Acad Med Singap. 2008;37:273-8.
  • 10. Jinzhong Zhao. Anatomical single-bundle transtibial anterior cruciate ligament reconstruction. Arthrosc Tech. 2020;29:1275-1282.
  • 11. Guglielmetti LG, Cury Rde P, de Oliveira VM, de Camargo OP, Severino NR, Fucs PM. Anterior cruciate ligament reconstruction: a new cortical suspension device for femoral fixation with transtibial and transportal techniques. J Orthop Surg Res. 2014;9:110.
  • 12. Alentorn-Geli E, Lajara F, Samitier G, Cugat R. The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18:1013–37.
  • 13. Yau WP, Fok AW, Yee DK. Tunnel positions in transportal versus transtibial anterior cruciate ligament reconstruction: a case-control magnetic resonance imaging study. Arthroscopy. 2013;29:1047–52.
  • 14. Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH. Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc. 2012;20:2200–7.
  • 15. Song EK, Kim SK, Lim HA, Seon JK. Comparisons of tunnel-graft angle and tunnel length and position between transtibial and transportal techniques in anterior cruciate ligament reconstruction. Int Orthop. 2014;38:2357–62.
  • 16. Mandal A, Shaw R, Biswas D, Basu A. Transportal versus transtibial drilling technique of creating femoral tunnel in arthroscopic anterior cruciate ligament reconstruction using hamstring tendon autograft. J Indian Med Assoc. 2012;110:773–5.
  • 17. Brown CH Jr, Spalding T, Robb C. Medial portal technique for singlebundle anatomical anterior cruciate ligament (ACL) reconstruction. Int Orthop. 2013;37:253–69.
  • 18. Haitao Chen, Kai Tie, Yongjian Qi, Bin Li, Biao Chen, Liaobin Chen. Anteromedial versus transtibial technique in single-bundle autologous hamstring ACL reconstruction: a meta-analysis of prospective randomized controlled trials. J Orthop Surg Res. 2017;12:167
  • 19. Azboy I, Demirtas A, Gem M, Kiran S, Alemdar C, Bulut M. A comparison of the anteromedial and transtibial drilling technique in ACL reconstruction after a short-term follow-up. Arch Orthop Trauma Surg. 2014;134:963–9.
  • 20. Tasdemir Z, Gulabi D, Saglam F, Tokgoz Ozal S, Elmali N. 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? Acta Orthop Traumatol Turc. 2015;49:483–491.
  • 21. Ozel O, Yucel B, Orman O, Demircay E, Mutlu S. Comparison of anteromedial and transtibial ACL reconstruction using expandable fixation. Orthopedics. 2017:1;40:532-537
  • 22. Sisk TD. Knee Injuries. In: Campbell’s Operative Orthopaedics, 1996;8:1487–732.
  • 23. Krause M, Freudenthaler F, Frosch KH, Achtnich A, Petersen W, Akoto R. Operative Versus Conservative Treatment of Anterior Cruciate Ligament Rupture. Dtsch Arztebl Int. 2018;24;115:855-862
  • 24. Tashman S, Araki D. Effects of ACL reconstruction on in vivo, dynamic knee function. Clin Sports Med. 2013;32:47–59.
  • 25. Tie K, Chen L, Hu D, Wang H. The difference in clinical outcome of single-bundle anterior cruciate ligament reconstructions with and without remnant preservation: A meta-analysis. Knee. 2016;23:566–74.
  • 26. Kilinc BE, Kara A, Oc Y, Celik H, Camur S, Bilgin E. et al. Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A retrospective cohort study. Int J Surg. 2016;29:62–9
  • 27. Kyung HS, Baek SG, Lee BJ, Lee CH. Single-bundle anterior Cruciate ligament reconstruction with semitendinosus tendon using the PINNACL crosspin system: minimum 4-year follow-up. Knee Surg Relat Res. 2015;27:43–48
  • 28. Zhang Y, Xu C, Dong S, Shen P, Su W, Zhao J. Systemic review of anatomic single- versus double-bundle anterior cruciate ligament reconstruction: does femoral tunnel drilling technique matter? Arthroscopy. 2016;32:1887–904.
  • 29. Silva A, Sampaio R, Pinto E. ACL reconstruction: comparison between transtibial and anteromedial portal techniques. Knee Surg Sports Traumatol Arthrosc. 2012;20:896–903.
  • 30. Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, et al. Nonanatomic tunnel position in traditional transtibial single bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am. 2010;92:1427–31
  • 31. Hefzy MS, Grood ES, Noyes FR. Factors affecting the region of most isometric femoral attachments. Part II: The anterior cruciate ligament. Am J Sports Med. 1989;17:208-16.
  • 32. Silver AG, Kaar SG, Grisell MK, Reagan JM, Farrow LD. Comparison between rigid and flexible systems for drilling the femoral tunnel through an anteromedial portal in anterior cruciate ligament reconstruction. Arthroscopy. 2010;26:790-5
  • 33. Mirzatolooei F. Comparison of short term clinical outcomes between transtibial and transportal TransFix(R) femoral fixation in hamstring ACL reconstruction. Acta Orthop Traumatol Turc. 2012;46:361–366.
  • 34. Metso L, Nyrhinen KM, Bister V, Sandelin J, Harilainen A. Comparison of clinical results of anteromedial and transtibial femoral tunnel drilling in ACL reconstruction. BMC Musculoskeletal Disord. 2020;21:341.
  • 35. Jinzhong Zhao. Anatomical Single-Bundle Transtibial Anterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2020;29:1275-1282.
  • 36. Hatipoğlu MY, Bircan R, Özer H, Selek HY, Harput G, Baltacı YG. Radiographic assessment of bone tunnels after anterior cruciate ligament reconstruction: A comparison of hamstring tendon and bone-patellar tendon-bone autografting technique. Jt Dis Relat Surg 2021;32(1):122-128.

Ayrıntılar

Birincil Dil İngilizce
Konular Tıp
Bölüm ORIGINAL ARTICLE
Yazarlar

Alim Can BAYMURAT (Sorumlu Yazar)
Gazi University Faculty of Medicine, Department of Orthopedics and Traumatology
0000-0002-0062-621X
Türkiye


Mesut TAHTA
Egepol Surgery Hospital
0000-0001-9660-1350
Türkiye


Nazmi UYSAL Bu kişi benim
Menemen State Hospital
0000-0003-0559-9596
Türkiye

Yayımlanma Tarihi 31 Ocak 2022
Başvuru Tarihi 13 Kasım 2021
Kabul Tarihi 16 Aralık 2021
Yayınlandığı Sayı Yıl 2022, Cilt 3, Sayı 1

Kaynak Göster

APA Baymurat, A. C. , Tahta, M. & Uysal, N. (2022). A comparison of clinical results of transtibial and transportal anatomical techniques in the arthroscopic reconstruction of anterior cruciate ligament . Archives of Current Medical Research , 3 (1) , 18-23 . Retrieved from https://dergipark.org.tr/tr/pub/acmr/issue/68361/1021752

Archives of Current Medical Research (ACMR) provides instant open access to all content, bearing in mind the fact that presenting research

free to the public supports a greater global exchange of knowledge.

http://www.acmronline.org/