Failure rate analysis and clinical outcomes of two different femoral tunnel positions using anteromedial portal technique in anterior cruciate ligament reconstruction

A Tecame; F Buschini; F Dini; B Zampogna; A Ampollini; R Papalia; P Adravanti

doi:10.1016/j.knee.2022.02.010

Failure rate analysis and clinical outcomes of two different femoral tunnel positions using anteromedial portal technique in anterior cruciate ligament reconstruction

Knee. 2022 Mar:35:45-53. doi: 10.1016/j.knee.2022.02.010. Epub 2022 Feb 23.

Authors

A Tecame¹, F Buschini², F Dini³, B Zampogna², A Ampollini³, R Papalia², P Adravanti³

Affiliations

¹ Department of Orthopaedic and Trauma Surgery, "Città di Parma" Clinic, Parma, Italy. Electronic address: andrea.tecame@gmail.com.
² Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
³ Department of Orthopaedic and Trauma Surgery, "Città di Parma" Clinic, Parma, Italy.

PMID: 35219217
DOI: 10.1016/j.knee.2022.02.010

Abstract

Aim: To analyze two different femoral tunnel positions and to evaluate their correlation with clinical, functional outcomes and surgical revision rate in patients who underwent primary arthroscopic anterior cruciate ligament (ACL) reconstruction with anteromedial (AM) portal technique.

Methods: From January 2015 to October 2018, we recruited 244 patients that underwent primary single-bundle ACL reconstruction, using four strand-semitendinosus graft and AM portal technique for femoral tunnel placement. Patients were divided into two groups based on the different femoral tunnel positions: 117 patients of group A had ACL footprint center femoral tunnel position compared with 127 patients of group B, with femoral tunnel placement close to the AM bundle footprint. Preoperatively and at last follow up, all patients were assessed subjectively by Lysholm, Tegner, and International Knee Documentation Committee (IKDC) scores, while Lachman, Pivot-shift, and KT-1000 tests were performed to evaluate knee joint stability.

Results: Group B patients showed significantly better results in Lysholm, objective, and subjective IKDC scores compared with patients of group A (P < 0.001). A significantly higher surgical failure rate was found in group A than in group B (10.26% vs. 2.3%; P < 0.001). A higher anterior knee laxity was recorded in patients of group A than in patients of group B (1.9 ± 1.1 vs. 1.3 ± 1 mm; P < 0.001); a reduction in mean anterior tibial translation from preoperative to final follow up was found in group B compared with group A (3.5 ± 1.2 vs. 2.7 ± 1.1 mm; P < 0.001). No significant differences in the Tegner scale were found between the two groups.

Conclusion: ACL reconstruction performed using the AM portal technique showed better and more satisfactory clinical and functional outcomes associated with a lower failure rate when the femoral tunnel had been placed more eccentrically in the footprint, in the AM bundle center position.

Keywords: ACL failure; ACL reconstruction; Anteromedial portal technique; Femoral tunnel position.

MeSH terms

Anterior Cruciate Ligament Injuries* / surgery
Anterior Cruciate Ligament Reconstruction* / methods
Femur / surgery
Humans
Knee Joint / surgery
Magnetic Resonance Imaging
Tibia / surgery