Functional, clinical and biomechanical comparison of anterior cruciate ligament reconstruction with anatomical placement of transtibial tunnel placement

Objectives: Functional, clinical and biomechanical comparison of Anterior Cruciate Ligament reconstruction with anatomical placement of transtibial tunnel placement. Methods: 55 patients who can be adequately followed-up being divided into transtibial and anatomic groups. Lachman and Pivot-shift tests were performed to all patients. Laxity was measured by performing KT-1000 arthrometer test with 15,20 and 30 pounds power. Muscle strength were evaluated with Cybex II at 60 ° / sec, 240 ° / sec frequencies with flexion and extension peak torque. The maximum force values of untouched knee and the knee with surgery have been compared. Groups were evaluated by using IKDC knee ligament healing standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and return to fitness times of patients were compared. NCSS 2007 & PASS 2008 Statistical Software was used for statistical analysis. Results: Statistically, there was not any observed significant difference between Lachman and Pivot-shift levels. Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the cases which were subjected to transtibial technique. There was not any statistically significant difference between Lysholm activity levels of cases. Lysholm activity levels of patients who underwent anatomic techniques significantly higher than transtibial technique. There was not any statistically significant difference between Modified Cincinnati activity levels. Modified Cincinnati activity levels of patients who were subjected anatomical techniques, are significantly higher than transtibial technique. There was not any statistically significant difference between post treatment IKDC activity levels. Intense activity after treatment rate of patient who were subjected to anatomic techniques was significantly higher than transtibial technique. There was a statistically significant differences between Cybex extension-flexion 60 measurements and Extension 240 measurements. Results of KT-1000 arthrometer testing anatomical technique was found to be stable than transtibial technique in antero-posterior translation of the knee kinematics at 20 and 30 pounds of forces. Return to sport times of patients who underwent transtibial technique, significantly higher than anatomic technique. There was not any statistically significant difference between return to work times of patients. Conclusion: Previously published studies we observed that anatomic single band ACL reconstruction is better than transtibial ACL reconstruction by providing rotational and anterior translational stability control, in reducing the complications and it is more effective in returning normal functions after operation. As an important implication, a single-band anatomic ACL reconstruction’s clinical, functional and laboratory results are found to be better than the transtibial technique

Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A retrospective cohort study

WOS: 000375550000011PubMed ID: 26987514Introduction: Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT). Material method: Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 +/- 6, and 27.9 +/- 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60 degrees/sec, 240 degrees/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis. Result: There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p 0.05). Conclusion: Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics