Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction

Purpose: The clinical outcomes of transtibial (TT) and anteromedial (AM) drilling techniques for anterior cruciate ligament reconstruction in preparing the femoral tunnel were directly compared by using a systematic literature review.

Methods: PubMed, EMBASE, the Cochrane Library, and the ISI Web of Science were searched until 10 May 2014, using the following Boolean operators: transtibial AND (anteromedial OR transportal OR independent OR three portal OR accessory portal) AND anterior cruciate ligament. All prospective and retrospective controlled trials directly comparing physical examination and scoring system results between TT and AM techniques were retrieved. No language or publication year limitations were used in our analysis.

Results: Of 504 studies retrieved, nine studies involving 769 patients were included. Results suggested that the AM was superior to the TT technique for preparing the femoral tunnel independent of the International Knee Documentation Committee (IKDC) Score (n.s.). A higher proportion of negative Lachman (p = 0.002) and pivot-shift test (p = 0.01) results, lower manual maximum displacement by KT-1000 (p = 0.004), higher Lysholm scores (p = 0.034), a higher incidence of IKDC grade A/B (p = 0.04), and higher visual analogue scale scores (p = 0.00) were observed with the AM compared with the TT technique.

Conclusion: Although the increases in these scores were below the minimal clinically important difference, this systematic review indicated that the AM was superior to the TT drilling technique based on physical examination and scoring system results.

Level of evidence: Therapeutic study (systematic review), Level III.