Anteromedial portal technique versus trans-tibial technique for anterior cruciate ligament single-bundle reconstruction

Purpose
The purpose of this study was to determine, , − whether drilling the femoral tunnel through the anteromedial portal (AMP), as opposed to drilling the tunnel trans-tibially (TT), will increase the reliability to reach the center of the femoral insertion in single-bundle anterior cruciate ligament (ACL) reconstruction.
Patients and methods
Fifty-four consecutive patients undergoing primary ACL reconstruction with a four-strand hamstring tendon autograft were enrolled in a prospective case series. Cases were divided according to the landmarks used to identify the starting point of femoral tunnel into two groups: group I included patients in whom the ACL stump was used (24 patients), whereas group II included patients in whom the ACL stump was not found and the lateral intercondylar ridge was used (30 patients).
Results
Using the AMP resulted in a statistically significant higher incidence of reaching the anatomical femoral insertion site of the ACL compared with the TT approach (100 vs. 16.33%, <0.05). Comparison of the two groups showed that 3/24 patients in group I had an off-center position compared with 6/30 in group II, whereas 21/24 patients in group I had an outside position compared with 24/30 patients in group II, with no statistically significant difference between the two groups [Fisher’s exact test, =0.72; Relative Risk (RR)=1.4 (95% confidence interval=0.53–3.17)].
Conclusion
AMP technique allows more accurate positioning of the starting point of femoral tunnel when compared with the TT technique in anatomical single-bundle ACL reconstruction.
Level of evidence
Level IV (case series).