Femoral tunnel placement: Antero-medial versus Trans-Tibial for Anterior Cruciate Ligament Reconstruction by using Peroneus Longus Graft
DOI:
https://doi.org/10.51253/pafmj.v76iSUPPL-7.11978Keywords:
Anterior Cruciate Ligament Reconstruction, Femoral Tunnel Placement, Trans-TibialAbstract
Objective: To compare Antero-medial versus Trans-Tibial femoral tunnel placement for anterior cruciate ligament reconstruction by using peroneus longus graft.
Study Design: Prospective comparative study.
Place and Duration of Study: Orthopedic Department, Combined Military Hospital, Lahore Pakistan, from Jul 2020 to Jun 2023.
Methodology: We included all the young patients who underwent anterior cruciate ligament reconstruction via peroneus longus graft. Patients were randomly divided into two groups for comparison. One group had femoral tunnel placement via antero-tibial drilling while other had via trans-tibial route. Both the groups were followed up for three months for comparison of stability, achievement of anatomical position, pain score and muscle strength.
Results: A total of 125 patients who had ACL reconstruction surgery were recruited in this study. Mean age of these patients was 28.25±6.81 years. Out of the total study participants, 108(86.4%) were military personals while 17(13.6%) patients were civilian-non entitled. Out of 125 patients, 64(51.2%) had femoral tunnel placement via anteromedial route while 61(48.8%) had via transtibial route. Statistical analysis revealed that at the end of three months' patients in both groups had no statistically significant difference in stability of joint, achievement of anatomical position on x-ray, significant pain and muscle strength (p-value >0.05).
Conclusion: Both the methods used for femoral tunnel placement for reconstruction of anterior cruciate ligament by using peroneus longus graft were equally efficacious in terms of stability, achievement of anatomical position, pain score and muscle strength.
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1. Petersen W, Fink C, Kopf S. Return to sports after ACL reconstruction: A paradigm shift from time to function. Knee Surgery, Sports Traumatology. Arthroscopy 2017;25(5):1353-1355. http://doi.org/10.1007/s00167-017-4559-x
2. Paterno MV, Flynn K, Thomas S, Schmitt LC. Self-Reported Fear Predicts Functional Performance and Second ACL Injury After ACL Reconstruction and Return to Sport: A Pilot Study. Sports Health 2018;10(3):228-233. http://doi.org/10.1177/1941738117745806
3. Amin S, Guermazi A, LaValley M, Niu J, Clancy M, Hunter D et al. Complete anterior cruciate ligament tear and the risk for cartilage loss and progression of symptoms in men and women with knee osteoarthritis. Osteoarth Cart 2008;16(8):897-902. http://doi.org/10.1016/j.joca.2007.11.005
4. Ahmed ZT, Khan NH, Bilal S, Ameer S, Tanveer F, Tanveer M. Diagnostic Accuracy of Magnetic Resonance Imaging for Detection of Anterior Cruciate Ligament Tears Taking Arthroscopy as Gold Standard. Med Forum 2020;31(3):31-34.
5. Mok YR, Wong KL, Panjwani T, Chan CX, Toh SJ, Krishna L. Anterior cruciate ligament reconstruction performed within 12 months of the index injury is associated with a lower rate of medial meniscus tears. Knee Surg Sports Traumatol Arthrosc 2019;27(1):117-123. http://doi.org/10.1007/s00167-018-5027-y
6. Trung DT, Manh SL, Thanh LN, Dinh TC, Dinh TC. Preliminary Result of Arthroscopic Anterior Cruciate Ligament Reconstruction Using Anterior Half of Peroneus Longus Tendon Autograft. Open Access Maced J Med Sci 2019;7(24):4351-4356. http://doi.org/10.3889/oamjms.2019.390
7. Shekhar H, Srivastava A, Rajnish RK, Bhatt S, Jain AK, Haq RU. Clinical outcome and computer tomography based tunnel placement evaluation following arthroscopic anteromedial portal anterior cruciate ligament reconstruction in non-athletic population. Int J Burns Trauma 2022;12(6):232-240.
8. Moon HS, Song SY, Oh JU, Seo YJ. Effects of modified trans-tibial versus trans-portal technique on stress patterns around the femoral tunnel in anatomical single-bundle ACL reconstruction with different knee flexion angles using finite element analysis. BMC Musculoskelet Disord 2022 ;23(1):759. http://doi.org/10.1186/s12891-022-05713-y
9. Hussin EA, Aldaheri A, Alharbi H, Farouk HA. Modified transtibial versus anteromedial portal techniques for anterior cruciate ligament reconstruction, a comparative study. Open Access J Sports Med 2018;9(3):199-213. https://doi.org/10.2147/OAJSM.S157729
10. Rajput IM, Ali M, Siddiqui AA, Hussain N, Jatoi A, Sahito B. Clinical and Functional Outcome of Anatomical Trans-portal Arthroscopic Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft: One Year Follow up at Civil Hospital Karachi. Pak J Med Health Sci 2020;14(2):631-634.
11. Taşdemir Z, Gülabi D, Sağlam F, Tokgöz Özal S, Elmalı N. Does the anteromedial portal provide clinical superiority compared to the transtibial portal in anterior cruciate ligament reconstruction in nonprofessional athletes in short-term follow-up?. Acta Orthop Traumatol Turc 2015;49(5):483-491. http://doi.org/10.3944/AOTT.2015.15.0016
12. Kumar VK, Narayanan SK, Vishal RB. A study on peroneus longus autograft for anterior cruciate ligament reconstruction. Int J Res Med Sci 2020;8(1):183-188
13. Venosa M, Delcogliano M, Padua R, Alviti F, Delcogliano A. Femoral Tunnel Positioning in Anterior Cruciate Ligament Reconstruction: Anteromedial Portal versus Transtibial Technique-A Randomized Clinical Trial. Joints 2017 ;5(1):34-38. http://doi.org/10.1055/s-0037-1601413
14. Kopkow C, Lange T, Hoyer A, Lützner J, Schmitt J. Physical tests for diagnosing anterior cruciate ligament rupture. Cochrane Database Syst Rev 2018;2018(12):CD011925. http://doi.org/10.1002/14651858.CD011925.pub2
15. Murawski CD, Wolf MR, Araki D, Muller B, Tashman S, Fu FH. Anatomic Anterior Cruciate Ligament Reconstruction: Current Concepts and Future Perspective. Cartilage 2013;4(3 Suppl):27S-37S. http://doi.org/10.1177/1947603513486557
16. Harput G, Tunay VB, Ithurburn MP. Quadriceps and Hamstring Strength Symmetry After Anterior Cruciate Ligament Reconstruction: A Prospective Study. J Sport Rehabil 2020;30(1):1-8. http://doi.org/10.1123/jsr.2019-0271
17. Wen Z, Zhang H, Yan W, Zhao P, Hunag X, Xu Z, et al. Comparison of femoral oval tunnel technique and round tunnel technique in single-bundle anterior cruciate ligament reconstruction. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2020;34(3):323-329. http://doi.org/10.7507/1002-1892.201908030
18. Loucas M, Loucas R, D'Ambrosi R, Hantes ME. Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction: A Systematic Review. Orthop J Sports Med 2021;9(7):23259671211024591. http://doi.org/10.1177/23259671211024591
19. Gabr A, Khan M, Kini SG, Haddad F. Anteromedial Portal versus Transtibial Drilling Techniques for Femoral Tunnel Placement in Arthroscopic Anterior Cruciate Ligament Reconstruction: Radiographic Evaluation and Functional Outcomes at 2 Years Follow-Up [published online ahead of print, 2022 Sep 8]. J Knee Surg 2022;10(3):1055. http://doi.org/10.1055/s-0042-1755358
20. Dimitriou D, Cheng R, Yang Y, Helmy N, Tsai TY. Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model. Orthop J Sports Med 2022;10(5):23259671221096417. http://doi.org/10.1177/23259671221096417
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