Open AccessAnteromedial positioning of the femoral tunnel in anterior cruciate ligament reconstruction is the best option to avoid revision: a single surgeon registry
Author(s) -
Paula Leite Cury Ricardo,
Simabukuro Artur Mistieri,
Marques Oliveira Victor,
Escudeiro Diego,
Jorge Pedro Baches,
Severino Fabrício Roberto,
Guglielmetti Luiz Gabriel Betoni
Publication year - 2020
Publication title -
journal of experimental orthopaedics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 18
ISSN - 2197-1153
DOI - 10.1186/s40634-020-00225-x
Subject(s) - medicine , hamstring , anterior cruciate ligament , surgery , orthopedic surgery , nuclear medicine , orthodontics
Purpose The aim of the study is to compare the risk of revision of single‐bundle hamstring anterior cruciate ligament (ACL) reconstruction between the anteromedial, transtibial and outside‐in techniques. Methods This cohort study was based on data from a single surgeon’s registry. Patients who underwent primary single‐bundle ACL reconstruction with hamstring tendon using the anteromedial portal, transtibial and outside‐in technique, operated between 1 November 2003 to 31 December 2016, were eligible for inclusion. A minimum follow‐up of 2 years was used, and the end‐point of the study was revision surgery. Results The total number of registered surgeries identified was 665; 109 were excluded, and 556 was the final sample. The overall revision rate was 8.7%. The transtibial technique presented 14/154 [9.9%] of revisions, the transportal 11/96 [11.4%] and the outside‐in 22/306 [7.2%]. Separating the outside‐in group into central outside‐in and anteromedial (AM) outside‐in, 18/219 [8.2%] was found for the central outside‐in and 4/87 [4.5%] for the AM outside‐in technique. Statistical evaluation of the first comparison (transtibial vs. transportal vs. outside‐in) obtained p = (n.s.) The second comparison (transtibial vs. central transportal vs. central outside‐in vs. AM outside‐in, p = (n.s). Placement was also evaluated: high anteromedial placement (transtibial) vs. central (transportal and central outside‐in technique) vs. AM placement (AM outside‐in). The high AM placement presented 14/154 [9.9%] of revision, the central placement 29/315 [9.2%] and the AM placement 4/87 [4.5%], p = (n.s.) The AM placement was also compared with the other placements (high and central AM), p = (n.s.) Conclusion Based on the registry of a single surgeon during 14 years of ACL reconstruction, the placement of the femoral tunnel in the high anteromedial region was associated with a rupture rate of 9.9%, central placement with 9.2% and anteromedial placement with 4.5%.