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, 9, 199-213
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Modified Transtibial Versus Anteromedial Portal Techniques for Anterior Cruciate Ligament Reconstruction, a Comparative Study

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Modified Transtibial Versus Anteromedial Portal Techniques for Anterior Cruciate Ligament Reconstruction, a Comparative Study

Ehab Abdelbaki Hussin et al. Open Access J Sports Med.

Abstract

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.

Figures

Figure 1
Figure 1
Digital rolimiter.
Figure 2
Figure 2
ACL sagittal angle vs tibial graft angle. Abbreviation: ACL, anterior cruciate ligament.
Figure 3
Figure 3
Graft inclination angle vs femoral graft angle.
Figure 4
Figure 4
Femoral tunnel placement.
Figure 5
Figure 5
Tibial tunnel placement.
Figure 6
Figure 6
Tibial tunnel starting point (A) and guide angle (B).
Figure 7
Figure 7
Tibial drill guide positioning. Abbreviations: PCL, posterior cruciate ligament; AH of LM, anterior horn of lateral meniscus.
Figure 8
Figure 8
Posterolateral tibial tunnel widening.
Figure 9
Figure 9
Femoral notchoplasty.
Figure 10
Figure 10
External rotation of the femoral guide.
Figure 11
Figure 11
Modifications steps in MTTT. Abbreviation: MTTT, modified transtibial technique.
Figure 12
Figure 12
IKDC subjective score (A), Lysholm subjective score (B), and IKDC knee examination score (C). Notes: A, B, & C are grading levels of clinical examination; A is the best, C is the worst and B is intermediate. Abbreviation: IKDC, International Knee Documentation Committee.
Figure 13
Figure 13
AAMPT vs MTTT regarding radiological angles. Abbreviations: AAMPT, accessory anteromedial portal technique; MTTT, modified transtibial technique; ACL, anterior cruciate ligament; FGA, femoral graft angle; TGA, tibial graft angle.
Figure 14
Figure 14
AAMPT vs MTTT regarding tunnel placement. Abbreviations: AAMPT, accessory anteromedial portal technique; MTTT, modified transtibial technique.
Figure 15
Figure 15
AAMPT vs TTT in literature. Abbreviations: AM, anteromedial; TT, transtibial; AAMPT, accessory anteromedial portal technique; TTT, transtibial technique.
Figure 16
Figure 16
MTTT vs literature regarding GIA. Notes: Green text is referring to the value of inclination angle of the intact ACL. Abbreviations: MTTT, modified transtibial technique; GIA, graft inclination angle; AMT, anteromedial technique; ACL, anterior cruciate ligament.
Figure 17
Figure 17
MTTT vs literature regarding TTP. Notes: The green text is referring to the sagittal placement of the intact ACL on the tibial articular surface. Abbreviations: MTTT, modified transtibial technique; TTP, tibial tunnel placement; AMT, anteromedial technique; ACL, anterior cruciate ligament.
Figure 18
Figure 18
MTTT vs literature regarding FTP. Notes: The green text is referring to the sagittal placement of the intact ACL on the femoral condylar surface. Abbreviations: MTTT, modified transtibial technique; FTP, femoral tunnel placement; AMT, anteromedial technique; ACL, anterior cruciate ligament.

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