Transtibial technique <b><i>versus</i></b> two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation

Yanasse, Ricardo Hideki; Lima, Alisson Amoroso; Antoniassi, Rodrigo Silveira; Ezzedin, Danilo Abu; Laraya, Marcos Henrique Ferreira; Mizobuchi, Roberto Ryuiti

doi:10.1016/j.rboe.2016.04.001

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ORIGINAL ARTICLE • Rev. bras. ortop. 51 (03) • May-Jun 2016 • https://doi.org/10.1016/j.rboe.2016.04.001 copy

Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation^{^☆} ☆ Study conducted at the Service of Orthopedy and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To compare the transtibial and two-incision techniques for anterior cruciate ligament (ACL) reconstruction using a single band.

METHODS:

A prospective and randomized study was conducted in blocks. Patients underwent ACL reconstruction by means of two techniques: transtibial (group 1: 20 patients) or two incisions (group 2: 20 patients). The radiographic positioning of the tunnel, inclination of the graft, graft isometricity and functional results (IKDC and Lysholm) were evaluated.

RESULTS:

The positioning of the femoral tunnel on the anteroposterior radiograph, expressed as a mean percentage relative to the medial border of the tibial plateau, was 54.6% in group 1 and 60.8% in group 2 (p < 0.05). The positioning of the femoral tunnel on the lateral radiograph, expressed as a mean percentage relative to the anterior border of Blumensaat's line, was 68.4% in group 1 and 58% in group 2 (p < 0.05). The mean inclination of the graft was 19° in group 1 and 27.2° in group 2 (p < 0.05). The mean graft isometricity was 0.96 mm in group 1 and 1.33 mm in group 2 (p > 0.05). Group 2 had better results from the pivot-shift maneuver (p < 0.05).

CONCLUSION:

The technique of two incisions allowed positioning of the femoral tunnel that was more lateralized and anteriorized, such that the graft was more inclined and there was a clinically better result from the pivot-shift maneuver. There was no difference in isometricity and no final functional result over the short follow-up time evaluated.

Keywords:
Knee; Anterior cruciate ligament reconstruction; Radiography

	Mean (SD)		p-Value (Mann–Whitney)
	Group 1 – transtibial	Group 2 – two-incision
AP femoral tunnel (%)	54.6 (4.1)	60.8 (4.5)	0.0004
L femoral tunnel (%)	68.4 (10.9)	58.0 (9.9)	0.005
AP tibial tunnel (%)	45.4 (6.4)	45.2 (4.9)	0.11
L tibial tunnel (%)	43.5 (9.3)	38.1 (9.8)	0.12

	Mean (SD)		p-Value (Mann–Whitney)
	Group 1 – transtibial	Group 2 – two-incision
Graft inclination (°)	19.0 (3.7)	27.2 (5.7)	0.0005
Isometricity (mm)	0.96 (0.8)	1.33 (1.6)	0.69

	Group 1 – transtibial	Group 2 – two-incision	p-Value (Mann–Whitney U)
	Number of patients (%)	Number of patients (%)
Subjective IKDC
A	12 (85.7%)	11 (64.7%)	0.16
B	2 (14.3%)	4 (23.5%)
C	0 (0.0%)	2 (11.8%)

IKDC range of movement
A	10 (71.4%)	6 (35.3%)	0.09
B	3 (21.4%)	11 (64.7%)
C	1 (7.2%%)	0 (0.0%)

IKDC ligament exam
A	2 (14.3%)	6 (35.3%)	0.19
B	12 (85.7%)	11 (64.7%)
C	0 (0.0%)	0 (0%)

IKDC final
A	2 (14.3%)	3 (17.6%)	0.96
B	11 (78.6%)	12 (70.6%)
C	1 (7.1%)	2 (11.8%)

	Group 1 – transtibial mean (SD)	Group 2 – two-incision mean (SD)	p-Value (Mann–Whitney's U)
Post-operative Lysholm score	96.6 (4.5)	94.6 (4)	0.09
Post-operative Tegner score	5.9 (1.4)	5.2 (1.9)	0.32

	Group 1 – transtibial	Group 2 – two-incision	p-Value (Mann–Whitney's U)
	Number of patients (%)	Number of patients (%)
Lachman
0–2 mm	7 (50%)	8 (47.1%)	0.87
3–5 mm	7 (50%)	9 (52.9%)
6–10 mm	0 (0.0%)	0 (0%)

Pivot shift
Negative	4 (28.6%)	11 (64.7%)	0.04
+ glide	10 (71.4%)	6 (35.3%)
++ clunk	0 (0%)	0 (0%)

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] *Corresponding author. E-mail: ronibas@hotmail.com (R.S. Antoniassi).

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Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation☆ ☆ Study conducted at the Service of Orthopedy and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, SP, Brazil.

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Transtibial technique versus two incisions in anterior cruciate ligament reconstruction: tunnel positioning, isometricity and functional evaluation^{^☆} ☆ Study conducted at the Service of Orthopedy and Traumatology, Faculdade de Medicina de Marília (Famema), Marília, SP, Brazil.