Copyright ©The Author(s) 2015.
World J Orthop. Mar 18, 2015; 6(2): 252-262
Published online Mar 18, 2015. doi: 10.5312/wjo.v6.i2.252
Table 3 Clinical studies summary
Ref.YearStudy typeStudy sizeGraft typeFemoral tunnel positioningTibial tunnel positioningFollow-up timeOutcome measuresResults
Adebe et al[57]2011Retrospective cohort22 patientsHamstring and (BPTB)Anatomic vs non-anatomic-6-36 moTibial translation and rotationAnatomic tunnel more stable in terms of anterior and medial translation and internal rotation
Alentorn-Geli et al[65]2010Cross-sectional comparative47 patientsBPTBTranstibial vs anteromedial portal techniques-2-5 yrIKDC score; knee stability; ROM; one-leg hop test; mid-quadriceps circumference; VAS for satisfaction with surgery; Lysholm score; Tegner score; SF-12From AMP technique, significantly lower recovery time from surgery to walking without crutches, return to normal life, return to jogging, training and play. Significantly better knee stability values but no difference in other functional scores surgery
Avadhani et al[69]2010Prospective cohort41 patientsBPTB-AP position of tunnelMinimum 2 yrIKDC score; modified lysholm scorePlacing the tibial tunnel in the anterior 25% of the tibial plateau was associated with poor knee outcomes
Behrend et al[59]2006Retrospective cohort50 patientsBPTBPosition assessed using quadrant method of bernard and hertelPosition assessed using criteria of staubli and rauschningMean 19 moIKDC scoreMore anterior the femoral canal, highly significant correlation with poorer IKDC score. Position of the tibial tunnel had no statistically significant effect on IKDC score
Duffee et al[61]2013[6]Prospective cohort436 patientsHamstring and BPTBTranstibial vs anteromedial portal techniques-6 yrKOOSNo difference between the techniques in terms of predicting functional outcome with KOOS
Fernandes et al[60]2014Prospective cohort86 patientsHamstring and BPTBAnteromedial footprint (anatomic) and high anteromedial position-6 and 12 moIKDC score; tegner score; lysholm scale; return to sportsFemoral tunnel positions at AM footprint and high AM position associated with earlier return to sports on previous Tegner score level and better functional outcomes at 12 mo
Franceschi et al[62]2013Retrospective cohort94 patientsHamstringTranstibial vs anteromedial portal techniques-Minimum 5 yrIKDC score; Lysholm scale; KT-1000 arthrometer; Lachman test; Pivot shift test; radiographic assessmentNo difference between the two techniques in terms of functional scores (lysholm and IKDC) though the anteromedial portal technique provided better rotational and anterior translational stability
Hatayama et al[68]2013Prospective cohort60 patientsHamstring-AP position of tibial tunnel2 yrPivot shift test; stress radiographs; 2nd look arthroscopyAnterior placement of the tibial tunnel inside the footprint led to better anterior knee stability
Hosseini et al[58]2012Retrospective cohort26 patientsHamstring, BPTB and allograftNon-anatomicNon-anatomic-Patients undergoing revision ACL surgery: MRI based 3D modellingBoth the tibial and femoral tunnel positions in the failed ACLR were non-anatomic compared to native ACL values
Jepsen et al[55]2007Prospective randomised trial60 patientsHamstringHigh (1 o’clock) vs Low (2 o’clock) positions-1 yrLaxity; IKDC Evaluation and Examination forms; radiograph assessmentNo significant difference in the laxity at 25 degrees and 70 degrees or scores on the IKDC examination form. Significant difference in the scores on the IKDC evaluation form
Koutras et al[64]2013Prospective cohort51 patientsHamstringTranstibial vs anteromedial portal techniques-3 and 6 moLysholm score; isokinetic tests; functional testsAMP technique had significantly better suggesting a quicker return to function and performance
Noh et al[52]2013Prospective randomised trial61 patientsAllograftTranstibial vs anteromedial portal techniques-Mean 30.2 moLachman test; pivot shift test; IKDC score; lysholm score; tegner activity scale; radiograph and MRI assessmentAMP technique resulted in a more posterior femoral tunnel position than the TT technique and knees with this technique were more stable with a higher lysholm score
Ohsawa et al[67]2012Retrospective cohort121 patientsHamstring-Posterior tibial landmark vs anterior tibia landmarkMinimum 2 yr3D CT; 2nd look arthroscopy + EUA; Lachman, pivot shift and side-side stability tests; lysholm scorePivot shift and side to side stability tests and knee flexion were significantly better in the anterior landmark group
Park et al[54]2010Cross-sectional70 patientsAllograftHigh (1 o’clock) vs low (2 o’clock) positions-IntraoperativeIntraoperative anterior and rotational knee stability at differing degrees of flexionThe low femoral tunnel group showed significantly better intraoperative internal rotational stability at 0° and 30° of flexion
Rahr-Wagner et al[63]2013Prospective cohort9239 patients-Transtibial vs anteromedial technique-4 yrNeed for revision; pivot-shift and instrumented objective testIncreased risk of revision ACL surgery when using the AM technique compared with the TT technique
Sadoghi et al[56]2011Prospective cohort53 kneesHamstring and BPTBAnatomic vs non-anatomicAnatomic vs non-anatomic1 yr3D CT; Tegner score;WOMAC score; IKDC score; KT-1000 arthrometer measurements; pivot-shift testSignificantly superior clinical outcome in anatomic ACL reconstructions in terms of higher clinical scores (tegner and IKDC), higher anterior posterior stability, and less pivot shift
Seon et al[53]2011Prospective cohort58 patientsAllograftHigh (1 o’clock) vs low (2 o’clock) positions-Minimum 2 yrLysholm; Tegner; Clinical and radiographic stabilityLow tunnel group had significantly better internal rotational stability at 0 and 30 degrees of knee flexion
Seo et al[66]2013Retrospective cohort89 patientsAllograftTranstibial vs“outside in” techniques-Minimum 1 yr3D CT; pivot-shift; lachman; IKDC; lysholm; tegner; ROMA more anatomical femoral tunnel with better knee joint rotational stability on pivot shift test
Taketomi et al[51]2013Case series34 patientsHamstringAnatomic-2 yrLysholm score; IKDC score; KT-2000 arthrometer; lachman test; reverse pivot-shift testExcellent short-term using the anatomic femoral tunnel objectively, subjectively and in terms of knee stability