Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis
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In anterior cruciate ligament (ACL) reconstruction, there is concern regarding the potential risk of femoral tunnel widening in the anteromedial portal (AMP) technique due to the acute graft-bending angle at the aperture and the more elliptical aperture shape of the femoral tunnel compared to the transtibial (TT) techniques. Therefore, the aim of the current systematic review and meta-analysis was to compare the femoral tunnel widening between the AMP and TT techniques in patients who underwent ACL reconstruction.
It should be included the studies that reported on femoral tunnel widening in patients who underwent single-bundle ACL reconstruction, using soft-tissue tendon graft, with AMP and/or TT techniques. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACL reconstruction.
Twenty-one studies were finally included in this meta-analysis. The pooled changes of absolute millimeters of tunnel widening from the immediate postoperative status to the last follow-up did not differ significantly between the AMP and TT techniques at both the aperture [3.31 mm, 95% confidence interval (CI) 1.7–5.0. mm versus 2.9 mm, 95% CI 2.4–3.4 mm, P = n.s.] and the midportion (3.5 mm, 95% CI 0.8–6.3 mm versus 3.0 mm, 95% CI 2.2–3.9 mm, P = n.s.) of the femoral tunnel. No significant difference was observed between the two techniques in the relative percentage of femoral tunnel widening (AMP; 28.8%, 95% CI 14.8–42.9% vs. TT; 29.7%, 95% CI 15.6–43.7%, P = n.s.).
No significant difference in femoral tunnel widening was observed between the AMP and TT techniques, both in absolute millimeter and relative percentage, in patients who underwent single-bundle ACL reconstruction. This finding could alleviate the potential concerns associated with femoral tunnels being wider for the AMP than for the TT technique.
Level of evidence
KeywordsAnterior cruciate ligament reconstruction Tunnel widening Anteromedial portal Transtibial
This study was supported by SMC-Ottogi Research Fund (SMX1162171).
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict interest.
This article does not contain any studies with human participants performed by any of the authors.
For this type of study, formal consent is not required.
- 5.Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS, Hart JM (2008) Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc 16:1108–1113CrossRefPubMedGoogle Scholar
- 9.Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10:2–11CrossRefPubMedGoogle Scholar
- 13.Hwang DH, Shetty GM, Kim JI, Kwon JH, Song JK, Munoz M, Lee JS, Nha KW (2013) Does press-fit technique reduce tunnel volume enlargement after anterior cruciate ligament reconstruction with autologous hamstring tendons? A prospective randomized computed tomography study. Arthroscopy 29:83–88CrossRefPubMedGoogle Scholar
- 15.Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ, Tallroth K (1999) Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 7:290–295CrossRefPubMedGoogle Scholar
- 17.Kawaguchi Y, Kondo E, Kitamura N, Kai S, Inoue M, Yasuda K (2011) Comparisons of femoral tunnel enlargement in 169 patients between single-bundle and anatomic double-bundle anterior cruciate ligament reconstructions with hamstring tendon grafts. Knee Surg Sports Traumatol Arthrosc 19:1249–1257CrossRefPubMedGoogle Scholar
- 23.Mermerkaya MU, Atay OA, Kaymaz B, Bekmez S, Karaaslan F, Doral MN (2015) Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods. Knee Surg Sports Traumatol Arthrosc 23:2283–2291CrossRefPubMedGoogle Scholar
- 25.Moisala AS, Jarvela T, Paakkala A, Paakkala T, Kannus P, Jarvinen M (2008) Comparison of the bioabsorbable and metal screw fixation after ACL reconstruction with a hamstring autograft in MRI and clinical outcome: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 16:1080–1086CrossRefPubMedGoogle Scholar
- 28.Otsuka H, Ishibashi Y, Tsuda E, Sasaki K, Toh S (2003) Comparison of three techniques of anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Differences in anterior tibial translation and tunnel enlargement with each technique. Am J Sports Med 31:282–288CrossRefPubMedGoogle Scholar
- 30.Robbrecht C, Claes S, Cromheecke M, Mahieu P, Kakavelakis K, Victor J, Bellemans J, Verdonk P (2014) Reliability of a semi-automated 3D-CT measuring method for tunnel diameters after anterior cruciate ligament reconstruction: a comparison between soft-tissue single-bundle allograft vs. autograft. Knee 21:926–931CrossRefPubMedGoogle Scholar
- 33.Saccomanno MF, Shin JJ, Mascarenhas R, Haro M, Verma NN, Cole BJ, Bach BR Jr (2014) Clinical and functional outcomes after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral suspensory fixation: a systematic review of randomized controlled trials. Arthroscopy 30:1491–1498CrossRefPubMedGoogle Scholar
- 43.Vadala A, Iorio R, De Carli A, Argento G, Di Sanzo V, Conteduca F, Ferretti A (2007) The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study. Knee Surg Sports Traumatol Arthrosc 15:365–371CrossRefPubMedGoogle Scholar