Antero-medial portal vs. transtibial techniques for drilling femoral tunnel in ACL reconstruction using 4-strand hamstring tendon: A cross-sectional study with 1-year follow-up

BACKGROUND Antero-medial portal (AMP) and trans-tibial (TT) techniques are the most widely used methods for drilling femoral tunnel in ACL reconstructions; yet, debate continues about the preferred method. This study seeks to compare these 2 techniques in patients with ACL tears. MATERIAL/METHODS In this comparative study, all cases of isolated ACL reconstruction using 4-strand hamstring tendon in 2006-2010 were evaluated for eligibility. Of 266 patients, 124 cases (60 TT and 64 AMP), with the mean age of 28.48±8.3, met the inclusion criteria. Both groups were compared in 8 follow-ups from the point of view of time of: return to post-surgical activities (including walking without crutches, normal life activity, jogging, and exercising), maximum range of passive movements, knee instability (Lachman test), functional condition (subjective IKDC and Lysholm knee scores), therapeutic outcomes, and patient's satisfaction with treatment (VAS). RESULTS AMP technique significantly accelerates patients' return to activity. AMP patients achieved full range of motion much sooner than TT cases (P<0.0001). After 1-year follow-up, S-IKDC scores were 94.8 ± 3.9 and 89.2 ± 4.1 and S-LKS scores were 96.1 ± 3 and 92.2 ± 4.1 for AMP and TT groups, respectively (P<0.0001). Knee stability was similar in both groups on Lachman test (P=0.25). AMP group patients (VAS mean score: 9.78 ± 0.4) had greater satisfaction compared to TT group patients (VAS mean score: 9.53 ± 0.5) (P=0.003). CONCLUSIONS AMP technique leads to reduction in time to return to routine activities, better therapeutic outcomes and higher satisfaction rates.