Radiological and functional comparison of single-bundle anterior cruciate ligament reconstruction: transtibial versus anteromedial technique

Abstract

Background/aim: This study aimed to compare radiological and functional outcomes of patients who had single-bundle anterior cruciate ligament (ACL) reconstruction with autologous hamstring tendon grafts using transtibial (TT) versus anteromedial (AM) femoral tunnel drilling techniques. Materials and methods: Sixty patients who had been operated on between 2010 and 2013 were enrolled in this study. Tunnel positions and widenings in the femur and tibia were evaluated with radiographs, arthrometric measurements with a Rolimeter arthrometer (Aircast, Summit, NJ, USA), stability assessment with Lachman and reverse pivot shift tests, and functional assessment with the International Knee Documentation Committee and Tegner and Lysholm scoring systems. Results: Tunnel enlargement in the sagittal and coronal planes of the femur was higher with the TT technique (P < 0.0001) and that of the coronal planes of the tibia was also higher with the TT technique (P = 0.01). During the assessment with the Rolimeter, the difference between sides was significant with the TT technique (P = 0.013). Positive results of the Lachman and reverse pivot shift tests were more frequent with the TT technique (P < 0.05), and the Lysholm scores were higher with the AM technique (P = 0.001). Conclusion: ACL reconstruction with hamstring autografts by either TT or AM technique demonstrated similar and excellent results in terms of functional outcomes at the end of the first postoperative year. The TT group had increased tunnel enlargement, which may have uncertain long-term outcomes, compared with the AM group.