Femoral positioning influences ipsi-and contralateral anterior cruciate ligament rupture following its reconstruction: Systematic review and meta-analysis

AIM To systematically review the incidence of ipsilateral graft re-rupture and contralateral anterior cruciate ligament (ACL) rupture following its reconstruction, with special attention to the femoral drilling technique. METHODS Systematic review and meta-analysis of high-level prospective studies searched in MEDLINE database following PRISMA statement. The rate of ipsilateral graft re-rupture and contralateral rupture in patients submitted to either transtibial (TT) technique (isometric) or anteromedial (AM) technique (anatomic) was compared. RESULTS Eleven studies met the criteria and were included in final analysis. Reconstructions using the AM technique had a similar chance of contralateral ACL rupture when compared to the chance of ipsilateral graft failure (OR = 1.08, P = 0.746). In reconstructions using TT technique, the chance of contralateral ACL rupture was approximately 1.5 times higher than ipsilateral graft failure (OR = 1.49, P = 0.048). Incidence of contralateral lesions were similar among the techniques TT (7.4%) and AM (7.0%) (P = 0.963), but a trend could be noticed with a lower incidence of lesion in the ipsilateral limb when using the TT technique (4.9%) compared to the AM technique (6.5%) (P = 0.081). CONCLUSION ACL reconstruction by TT technique leads to lower incidence of graft re-injury than contralateral ACL lesion. There is no difference between the chance of re-injury after AM technique and the chance of contralateral ACL lesion (native ligament) with either technique.