Anteromedial portal versus transtibial drilling techniques in anterior cruciate ligament reconstruction: any clinical relevance? A retrospective comparative study

Arthroscopy. 2013 Aug;29(8):1330-7. doi: 10.1016/j.arthro.2013.05.020.


Purpose: This study aimed to undertake a retrospective analysis of prospectively collected data comparing, at a minimum follow-up of 5 years (78.1 ± 5.3 months v 75.6 ± 4.8 months), the clinical, functional, and radiographic outcomes of 2 homogeneous groups of athletes who had undergone arthroscopic single-bundle autologous hamstring reconstruction of the anterior cruciate ligament (ACL) using a transtibial (TT) or an anteromedial portal (AMP) approach to drill the femoral tunnel.

Methods: Ninety-four patients were operated on in 2005 and 2006, and 88 (93.6%) (73 men, 15 women) were evaluated subjectively and objectively, using the Lysholm and International Knee Documentation Committee (IKDC) scores, manual maximum displacement test with a KT-1000 arthrometer (MEDmetric, San Diego, CA) and the Lachman test, and rotational instability with the pivot shift test. Degenerative changes were assessed on radiographs according to the Fairbank classification.

Results: The median age at operation was 29 years (20 to 43 years; SD, 5.4) in the TT group 1 and 28 years (19 to 45 years; SD, 6.1) in the AMP group 2. At the last appointment, the 2 groups had similar results for the Lysholm and IKDC scores (primary outcome). Patients who underwent the AMP approach had less glide pivot shift (P = .42) and Lachman (P = .47) phenomena, with no statistically significant intergroup difference. Radiography showed fewer, but not significantly different, degenerative changes in the AMP ACL reconstruction group at final follow-up (P = .47).

Conclusions: In our series, ACL reconstruction using a femoral tunnel drilled through an AMP provided better rotational stability and anterior translation than drilling the femoral tunnel using the TT technique. This difference likely is not relevant from a clinical and functional viewpoint. The 2 groups of patients were not significantly different in terms of development of degenerative changes seen radiographically at a minimum follow-up of 5 years.

Level of evidence: Level III, retrospective comparative study.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Anterior Cruciate Ligament / physiopathology
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Anterior Cruciate Ligament Reconstruction / rehabilitation
  • Arthroscopy / methods*
  • Athletic Injuries / physiopathology
  • Athletic Injuries / rehabilitation
  • Athletic Injuries / surgery*
  • Bone Screws
  • Female
  • Femur / surgery
  • Follow-Up Studies
  • Humans
  • Joint Instability / diagnosis
  • Joint Instability / physiopathology
  • Joint Instability / surgery
  • Knee Joint / physiopathology
  • Knee Joint / surgery
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tibia / surgery
  • Treatment Outcome
  • Young Adult