Transtibial versus transportal techniques for anterior cruciate ligament (ACL) reconstruction: a clinical study of military patients

Reconstruction of anterior cruciate ligament (ACL) injuries using arthroscopic single-bundle method is a common procedure with a success rate of 83% to 95%. Some studies have shown that the transportal method for drilling the femoral tunnel results in a higher success rate than transtibial approach. Other studies show equal rate of success in both approaches. The aim of this study was to investigate which one of the two methods has nearest biomechanics to the original ACL and better outcome for patients.

This study was a cross sectional (prospective) follow up. The clinical results of the ACL reconstruction in military patients with pure ACL rupture were evaluated and followed up. In one group 26 ACL reconstruction was done using the transportal (TP) technique and in the other group 20 ligaments were reconstructed using the transtibial (TT) method.

At the final follow-up, eight patients (40%) in the TT group and five cases (19.23%) in the TP group had a positive pivot test. Three patients (15%) in the TT group and nine patients (34.61%) in the TP group had a positive Lachman test. There was no statistically significant difference in the pivot test (P=0.06) and Lachman test (P=0.35) between the two groups. Mean Lysholm scores were 92.8 ± 2.5 and 93.2 ± 2.8 in the TT and the TP groups, respectively (P = 0.51). The averages of the graft angle were 68.7 ± 2.9 and 43.6 ± 4.1 in TT and the TP groups, respectively (p = 0.001). Any correlation between the graft angle and the patients’ concurrence (Lysholm score) after surgery (P>0.05) and any correlation between the graft angle and the instability testes (P>0.05) were not observed between the two groups.

No significant clinical difference was found between  the two techniques.
No significant clinical differences were found between two techniques and therefore, both of them can create good results.