COMPARATIVE STUDY ON ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH TRANSTIBIAL TECHNIQUE AND THROUGH ANTEROMEDIAL APPROACH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WEIZhaolan , LIFuming , PENGWeiqiu , WEIBaochen , QIULibiao , WEIChaoxi

Department of Orthopaedics, the People's Hospital of Liuzhou City, the First Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou Guangxi, 545000, P. R. China;

Corresponding author：

WEIZhaolan, Email: wei_zhaolanrmyy@126.com

Keywords：

Anterior cruciate ligament reconstruction; Arthroscopy; Transtibial technique; Anteromedial approach

DOI：

10.7507/1002-1892.20140076

Video：

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Objective To compare the effectiveness of the arthroscopic anterior cruciate ligament (ACL) reconstruction with the transtibial technique and through anteromedial approach. Methods Between April 2008 and May 2012, 86 patients (86 knees) with ACL rupture underwent single bundle reconstruction with autogeneic hamstring tendons with the transtibial technique in 44 cases (group A) and through anteromedial approach in 42 cases (group B). There was no significant difference in age, gender, injury causes, injury to admission time, preoperative International Knee Documentation Committee (IKDC) score, and Lysholm score between 2 groups (P>0.05). The femoral and tibia tunnels were measured by X-ray films and CT. The knee stability and function were evaluated by Lachman test, pivot shift test, IKDC score, and Lysholm score. Results The patients were followed up 1-2 years (mean, 1.5 years) in group A and 1 year-1 year and 6 months (mean, 1.2 years) in group B. No limitation of knee motion was observed. The Lysholm score and IKDC score were significantly increased at 1 year after operation when compared with preoperative scores in 2 groups (P<0.05), but no significant difference was found between 2 groups (P>0.05). At 1 year after operation, the stability of the knee in group B was significantly better than that in group A, and the results of Lachman test and pivot shift test showed significant differences between 2 groups (P<0.05). The femoral tunnel in group A was significantly longer in length and bigger in coronal angles and sagittal location than that in group B (P<0.05). Conclusion ACL reconstruction through anteromedial approach is a surgical technique to be closer to anatomy reconstruction, which can obtain better rotation function and stability of the knee than the transtibial technique.

Citation： WEIZhaolan, LIFuming, PENGWeiqiu, WEIBaochen, QIULibiao, WEIChaoxi. COMPARATIVE STUDY ON ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH TRANSTIBIAL TECHNIQUE AND THROUGH ANTEROMEDIAL APPROACH. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(3): 339-344. doi: 10.7507/1002-1892.20140076 Copy

1.	Culvenor AG, Cook JL, Collins NJ, et al. Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction. A narrative literature review. Br J Sports Med, 2013, 47(2):66-70.
2.	Friel NA, Chu CR. The role of ACL injury in the development of posttraumatic knee osteoarthritis. Clin Sports Med, 2013, 32(1):1-12.
3.	Van de Velde SK, Gill TJ, DeFrate LE, et al. The effect of anterior cruciate ligament deficiency and reconstruction on the patellofemoral joint. Am J Sports Med, 2008, 36(6):1150-1159.
4.	Fithian DC, Paxton EW, Stone ML, et al. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med, 2005, 33(3):335-346.
5.	周敬滨, Zachary Working, Carola F. van Eck, 等. 前交叉韧带解剖重建理念与方法. 中国运动医学杂志, 2011, 30(6):511-518.
6.	Van Eck CF, Lesniak BP, Schreiber VM, et al. Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy, 2010, 26(2):258-268.
7.	Amis AA, Jakob RP. Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc, 1998, 6 Suppl 1:S2-12.
8.	Marcacci M, Zaffagnini S, Iacono F, et al. Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons. Knee Surg Sports Traumatol Arthrosc, 1998, 6(2):68-75.
9.	Webster KE, Palazzolo SE, McClelland JA, et al. Tibial rotation during pivoting in anterior cruciate ligament reconstructed knees using a single bundle technique. Clin Biomech (Bristol, Avon), 2012, 27(5):480-484.
10.	Musahl V, Bedi A, Citak M, et al. Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med, 2011, 39(2):289-295.
11.	Iriuchishima T, Horaguchi T, Kubomura T, et al. Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT. Knee Surg Sports Traumatol Arthrosc, 2011, 19(4):674-679.
12.	Taketomi S, Nakagawa T, Takeda H, et al. Anatomical placement of double femoral tunnels in anterior cruciate ligament reconstruction:anteromedial tunnel first or posterolateral tunnel first. Knee Surg Sports Traumatol Arthrosc, 2011, 1(3):424-431.
13.	Kopf S, Forsythe B, Wong AK, 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(6):1427-1431.
14.	Kopf S, Forsythe B, Wong AK, et al. Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D-CT study. Knee Surg Sports Traumatol Arthrosc, 2012, 20(11):2200-2207.
15.	Zantop T, Diermann N, Schumacher T, et al. Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction. Am J Sports Med, 2008, 36(4):678-685.
16.	Marchant BG, Noyes FR, Barber-Westin SD, et al. Prevalence of nonanatomical graft placement in a series of failed anterior cruciate ligament reconstructions. Am J Sports Med, 2010, 38(10):1987-1996.
17.	Hensler D, Working ZM, Illingworth KD, et al. Medial portal drilling:effects on the femoral tunnel aperture morphology during anterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2011, 93(22):2063-2071.
18.	Tompkins M, Milewski MD, Brockmeier SF, et al. Anatomic femoral tunnel drilling in anterior cruciate ligament reconstructions:use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med, 2012, 40(6):1313-1321.
19.	Hussein M, van Eck CF, Cretnik A, et al. Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction:281 cases with 3- to 5-year follow-up. Am J Sports Med, 2012, 40(3):512-520.
20.	Wang H, Fleischli JE, Zheng NN. Transtibial versus anteromedial portal technique in single-bundle anterior cruciate ligament reconstruction:outcomes of knee joint kinematics during walking. Am J Sports Med, 2013, 41(8):1847-1856.
21.	Koutras G, Papadopoulos P, Terzidis IP, et al. Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft:transtibial versus anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8):1904-1909.
22.	Bedi A, Musahl V, Steuber V, et al. Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction:an anatomic and biomechanical evaluation of surgical technique. Arthroscopy, 2011, 27(3):380-390.
23.	邢基斯, 冯宗权, 侯蕾, 等. 胫骨骨道定位对前交叉韧带单束重建的影响. 中国矫形外科杂志, 2012, 20(12):1092-1096.
24.	Bedi A, Raphael B, Maderazo A, et al. Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction:a cadaveric study of femoral tunnel length and obliquily. Arthroscopy, 2010, 26(3):342-350.

1. Culvenor AG, Cook JL, Collins NJ, et al. Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction. A narrative literature review. Br J Sports Med, 2013, 47(2):66-70.
2. Friel NA, Chu CR. The role of ACL injury in the development of posttraumatic knee osteoarthritis. Clin Sports Med, 2013, 32(1):1-12.
3. Van de Velde SK, Gill TJ, DeFrate LE, et al. The effect of anterior cruciate ligament deficiency and reconstruction on the patellofemoral joint. Am J Sports Med, 2008, 36(6):1150-1159.
4. Fithian DC, Paxton EW, Stone ML, et al. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med, 2005, 33(3):335-346.
5. 周敬滨, Zachary Working, Carola F. van Eck, 等. 前交叉韧带解剖重建理念与方法. 中国运动医学杂志, 2011, 30(6):511-518.
6. Van Eck CF, Lesniak BP, Schreiber VM, et al. Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy, 2010, 26(2):258-268.
7. Amis AA, Jakob RP. Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc, 1998, 6 Suppl 1:S2-12.
8. Marcacci M, Zaffagnini S, Iacono F, et al. Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons. Knee Surg Sports Traumatol Arthrosc, 1998, 6(2):68-75.
9. Webster KE, Palazzolo SE, McClelland JA, et al. Tibial rotation during pivoting in anterior cruciate ligament reconstructed knees using a single bundle technique. Clin Biomech (Bristol, Avon), 2012, 27(5):480-484.
10. Musahl V, Bedi A, Citak M, et al. Effect of single-bundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees. Am J Sports Med, 2011, 39(2):289-295.
11. Iriuchishima T, Horaguchi T, Kubomura T, et al. Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT. Knee Surg Sports Traumatol Arthrosc, 2011, 19(4):674-679.
12. Taketomi S, Nakagawa T, Takeda H, et al. Anatomical placement of double femoral tunnels in anterior cruciate ligament reconstruction:anteromedial tunnel first or posterolateral tunnel first. Knee Surg Sports Traumatol Arthrosc, 2011, 1(3):424-431.
13. Kopf S, Forsythe B, Wong AK, 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(6):1427-1431.
14. Kopf S, Forsythe B, Wong AK, et al. Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D-CT study. Knee Surg Sports Traumatol Arthrosc, 2012, 20(11):2200-2207.
15. Zantop T, Diermann N, Schumacher T, et al. Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction. Am J Sports Med, 2008, 36(4):678-685.
16. Marchant BG, Noyes FR, Barber-Westin SD, et al. Prevalence of nonanatomical graft placement in a series of failed anterior cruciate ligament reconstructions. Am J Sports Med, 2010, 38(10):1987-1996.
17. Hensler D, Working ZM, Illingworth KD, et al. Medial portal drilling:effects on the femoral tunnel aperture morphology during anterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2011, 93(22):2063-2071.
18. Tompkins M, Milewski MD, Brockmeier SF, et al. Anatomic femoral tunnel drilling in anterior cruciate ligament reconstructions:use of an accessory medial portal versus traditional transtibial drilling. Am J Sports Med, 2012, 40(6):1313-1321.
19. Hussein M, van Eck CF, Cretnik A, et al. Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction:281 cases with 3- to 5-year follow-up. Am J Sports Med, 2012, 40(3):512-520.
20. Wang H, Fleischli JE, Zheng NN. Transtibial versus anteromedial portal technique in single-bundle anterior cruciate ligament reconstruction:outcomes of knee joint kinematics during walking. Am J Sports Med, 2013, 41(8):1847-1856.
21. Koutras G, Papadopoulos P, Terzidis IP, et al. Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft:transtibial versus anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc, 2013, 21(8):1904-1909.
22. Bedi A, Musahl V, Steuber V, et al. Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction:an anatomic and biomechanical evaluation of surgical technique. Arthroscopy, 2011, 27(3):380-390.
23. 邢基斯, 冯宗权, 侯蕾, 等. 胫骨骨道定位对前交叉韧带单束重建的影响. 中国矫形外科杂志, 2012, 20(12):1092-1096.
24. Bedi A, Raphael B, Maderazo A, et al. Transtibial versus anteromedial portal drilling for anterior cruciate ligament reconstruction:a cadaveric study of femoral tunnel length and obliquily. Arthroscopy, 2010, 26(3):342-350.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARATIVE STUDY ON ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH TRANSTIBIAL TECHNIQUE AND THROUGH ANTEROMEDIAL APPROACH

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