Purpose: This study compared the accessory anteromedial portal (AAMP) and the modified transtibial technique (MTTT)" for single-bundle anterior cruciate ligament (ACL) reconstruction.
Patients and methods: Sixty active adult patients with ACL tear were randomly assigned into two equal groups who were treated surgically. One group was operated on using AAMP and the other group through MTTT. Both the groups had the same postoperative course and were followed for 1 year after surgery. The follow-up included Lysholm and International Knee Documentation Committee (IKDC) subjective knee evaluation forms, IKDC objective knee examination form, and radiological evaluation. Results were evaluated and compared with each other.
Results: There was no significant difference in subjective effects or clinical examination between the two groups. Regarding radiological angles, the AAMP had more oblique graft orientation in the coronal plane than the MTTT, but both were found to be more slanted than native ACL. Also, the MTTT had succeeded to place the graft and tunnel more obliquity than the traditional non-anatomic TTT and better than the anatomic ranges despite having the graft inclination of the AAMP higher than the MTTT. The complaints from the patients and subjective scoring were found to be positively related to graft stability. Patients with healthier preoperative subjective state had a smoother postoperative period and better outcome.
Conclusion: This study offers simple modifications to the transtibial technique to allow near anatomic ACL reconstruction with similar results comparable to the AAMP and with fewer complications.
Keywords: AAMP; ACL; Arthroscopy; MTTT; Modified transtibial; anatomic; anterior cruciate ligament; arthroscopy; orthopedics.
Conflict of interest statement
Disclosure The authors report no conflicts of interest in this work.
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?Z Taşdemir et al. Acta Orthop Traumatol Turc 49 (5), 483-91. PMID 26422342.The AM technique has no clinical superiority compared to the TT technique in ACL reconstruction in nonprofessional athletes.
Anatomic Single-Bundle ACL Reconstruction Is Possible With Use of the Modified Transtibial Technique: A Comparison With the Anteromedial Transportal TechniqueJK Lee et al. J Bone Joint Surg Am 96 (8), 664-72. PMID 24740663.Tunnel characteristics including anatomic position, graft obliquity, and tunnel widening after single-bundle ACL reconstruction performed with use of the modified transti …
Transtibial Versus Anteromedial Portal Drilling for Anterior Cruciate Ligament Reconstruction: A Cadaveric Study of Femoral Tunnel Length and ObliquityA Bedi et al. Arthroscopy 26 (3), 342-50. PMID 20206044.The anteromedial portal technique allows for slightly greater femoral tunnel obliquity compared with transtibial drilling. However, there is a substantially increased ris …
Anteromedial Versus Transtibial Technique in Single-Bundle Autologous Hamstring ACL Reconstruction: A Meta-Analysis of Prospective Randomized Controlled TrialsH Chen et al. J Orthop Surg Res 12 (1), 167. PMID 29115973. - ReviewThe outcome of single-bundle ACL reconstruction with the AM technique is better than that with the TT technique in terms of postoperative stability and functional recover …
The Transtibial Versus the Anteromedial Portal Technique in the Arthroscopic Bone-Patellar Tendon-Bone Anterior Cruciate Ligament ReconstructionE Alentorn-Geli et al. Knee Surg Sports Traumatol Arthrosc 18 (8), 1013-37. PMID 19902178. - ReviewThe transtibial (TT) drilling of the femoral tunnel in the bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction was found to place the tunnel …
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