Differences in graft orientation using the transtibial and anteromedial portal technique in anterior cruciate ligament reconstruction: a magnetic resonance imaging study

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 17; no. 8; pp. 880 - 886
• Main Authors: Hantes, Michael Elias, Zachos, Vasilios C., Liantsis, Athanasios, Venouziou, Aaron, Karantanas, Apostolos H., Malizos, Konstantinos N.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.08.2009; Springer Nature B.V
• Subjects: Adult; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Arthroscopy - methods; Female; Humans; Knee; Knee Joint - pathology; Knee Joint - surgery; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Orthopedics; Retrospective Studies; Tendons - transplantation; Transplantation, Autologous; Anterior cruciate ligament reconstruction; Transtibial technique; Magnetic resonance imaging; Anteromedial portal technique
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-009-0738-8

The purpose of this study was to evaluate differences in graft orientation between transtibial (TT) and anteromedial (AM) portal technique using magnetic resonance imaging (MRI) in anterior cruciate ligament (ACL) reconstruction. Fifty-six patients who were undergoing ACL reconstruction underwent MRI of their healthy and reconstructed knee. Thirty patients had ACL reconstruction using the TT (group A), while in the remaining 26 the AM (group B) was used. In the femoral part graft orientation was evaluated in the coronal plane using the femoral graft angle (FGA). The FGA was defined as the angle between the axis of the femoral tunnel and the joint line. In the tibial part graft orientation was evaluated in the sagittal plane using the tibial graft angle (TGA). The TGA was defined as the angle between the axis of the tibial tunnel and a line perpendicular to the long axis of the tibia. The ACL angle of the normal knee in the sagittal view was also calculated. The mean FGA for group A was 72°, while for the group B was 53° and this was statistically significant ( P  < 0.001). The mean TGA for group A was 64°, while for the group B was 63° ( P  = 0.256). The mean intact ACL angle for group A was 52°, while for the group B was 51°. The difference between TGA and intact ACL angle was statistically significant ( P  < 0.001) for both groups. Using the AM portal technique, the ACL graft is placed in a more oblique direction in comparison with the TT technique in the femoral part. However, there are no differences between the two techniques in graft orientation in the tibial part. Normal sagittal obliquity is not restored with both techniques.