A Comparative Study of Clinical Outcome Between Transtibial and Anteromedial Portal Technique for Femoral Tunnel Construction.

Introduction: The most commonly employed technique of femoral tunnel placement, the trans-tibial technique, has been reported not to provide anatomical placement of femoral tunnel and result in rotational instability. Cadaveric and radiographic studies have conrmed that drilling the femoral tunnel through anteromedial portal allows a more anatomical placement of the tunnel and higher rotational stability than does the transtibial technique. However, clinical results of trans-tibial and anteromedial portal techniques are still controversial. A recent literature review showed improved short term results with anteromedial portal technique but no difference in terms of clinical functions between the two techniques at mid and long term follow up. Aim: To assess and compare clinical outcome between transtibial and anteromedial portal technique during arthroscopic single bundle anterior cruciate ligament reconstruction, using hamstring tendon autograft. Material & Methods: Our study was a prospective, randomized, comparative study which was conducted at the department of Orthopaedics, LLRM Medical College, Meerut, over a th th period of 2 year 3 months and (from 24 March 2015 to 30 june 2017). In our study, 30 cases were included as per the inclusion criteria. Out of them,15 cases had undergone arthroscopic single bundle ACL reconstruction with 4 strand hamstring tendon autograft, using anteromedial technique as a method for femoral tunnel drilling. In the other 15 cases transtibial technique was used instead of anteromedial technique. Both the groups were compared clinically using Lachman test, pivot-shift test, Lysholm score, and IKDC subjective and objective scores. Almost all Result: the cases were present in the age group 18 to 40 years, with mean age of the patients in anteromedial group was 25.8 years and in transtibial group was 28.53 years. 28 cases were males and 2 female cases. Medial meniscus was most commonly injured 10 (33.33%%) than the lateral meniscus 4(13.33%) patients. Partial meniscectomy was done in 5 (35.71%) patients who had signicant meniscal injury. Most of the cases in both the groups had grade III Lachman test positive 29 (96.67) pre-operatively. Post-operatively all patients became Lachman test negative. All patients in both the groups showed positive pivot-shift test pre-operatively. Post-operatively all patients became pivot-shift test negative. Both groups showed signicant improvement in knee stability based on Lachman and pivot-shift test, while no signicant difference was noted between the two groups. Conclusion: The result of anterior cruciate ligament reconstruction using quadrupled hamstring tendon autograft was good and comparable between the anteromedial and transtibial group in terms of post-operative knee stability and functional ability based on Lysholm score and IKDC score.