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Clinical and three-dimensional computed tomographic comparison between ACL transportal versus ACL transtibial
Guilherme Moreira de Abreu-e-Silva1, Daniel Soares Baumfeld2, Elton Luis Ribeiro Bueno2
1Orthopaedic Department, Universidade Federal de Minas Gerais and Hospital Felício Rocho, Minas Gerais, Brazil.
The transportal single-bundle anterior cruciate ligament (ACL) reconstruction technique better restores knee function and places tunnels closer to the native ACL footprint compared to the transtibial technique. Transtibial ACL reconstruction was associated with more mild instability.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomedical Engineering
Background:
- Single-bundle transtibial anterior cruciate ligament (ACL) reconstruction yields good results but may not fully restore knee function.
- Anatomical and biomechanical studies question the efficacy of the transtibial technique.
Purpose of the Study:
- To compare the clinical and tomographic outcomes of transportal versus transtibial single-bundle ACL reconstruction.
- Evaluate patient satisfaction, knee function, and tunnel placement accuracy.
Main Methods:
- Seventy-one patients with ACL tears were analyzed.
- Forty-one underwent transportal single-bundle ACL reconstruction; 30 underwent transtibial single-bundle ACL reconstruction.
- Clinical assessments and CT scans were used to evaluate outcomes.
Main Results:
- The transportal group demonstrated significantly better results in Lachman, pivot shift, anterior drawer, and arthrometer tests (p<0.05).
- CT evaluation indicated the transportal technique positioned the femoral tunnel closer to the native ACL footprint.
- The transtibial group experienced more mild, asymptomatic instability and extension deficits.
Conclusions:
- The transportal single-bundle technique offers superior tunnel placement accuracy compared to the transtibial technique.
- This improved anatomical positioning may contribute to better functional outcomes in ACL reconstruction.
- Transtibial technique is linked to higher rates of mild instability and extension deficits.
