Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique

Knee Surg Sports Traumatol Arthrosc. 2013 Aug;21(8):1904-9. doi: 10.1007/s00167-012-2323-9. Epub 2012 Dec 1.


Purpose: Several studies have suggested that drilling the femoral tunnel through an anteromedial arthroscopic portal during anterior cruciate ligament reconstruction allows more anatomic placement of the graft. However, no studies have investigated whether the anteromedial approach results in better outcomes compared to the traditional transtibial drilling approach when a hamstring autograft is used. The purpose of the present study is to investigate short-term functional and clinical outcome differences between male patients recovering from anterior cruciate ligament reconstruction with a hamstring autograft using the transtibial femoral tunnel drilling approach versus the anteromedial approach.

Methods: Lysholm score, functional test and isokinetic data were collected at 3 and 6 months after surgery in 51 male patients who received a standardized rehabilitation in a large outpatient facility. Multivariate and univariate analyses of variance were used to assess group, time and interaction effects.

Results: All outcomes except isokinetic knee flexion at 180°/s improved from 3 to 6 months for both groups (p ≤ 0.05). The anteromedial approach group had better Lysholm scores at 3 months (p ≤ 0.05) and better performance in the timed lateral movement functional tests at 3 and 6 months (p ≤ 0.05). No other comparisons were significant (n.s).

Conclusions: Both groups had comparable outcomes on most measures. The differences in the Lysholm score and lateral movement functional tests may suggest a quicker return of function and performance for the anteromedial approach group. Clinicians should take into consideration the surgical technique as they progress patients recovering from ACL reconstruction through the different phases of the rehabilitation protocol.

Level of evidence: Therapeutic study, Level II.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Analysis of Variance
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Anterior Cruciate Ligament Reconstruction / rehabilitation
  • Autografts
  • Double-Blind Method
  • Humans
  • Knee Joint / physiology
  • Male
  • Movement / physiology
  • Patient Outcome Assessment*
  • Prospective Studies
  • Recovery of Function
  • Tendons / transplantation*
  • Torque