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Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A Retrospective Cohort Study.
Int J Surg 2016; 29:62-9IJ

Abstract

INTRODUCTION

Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT).

MATERIAL METHOD

Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 ± 6, and 27.9 ± 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60°/sec, 240°/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis.

RESULT

There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p < 0.01). Lysholm Activity level of patients who had AT significantly higher than TT. There was no statistically significant difference between Modified Cincinnati activity level of the patients (p < 0.05). Modified Cincinnati activity level of patients who had AT were significantly higher than those had TT. There was no statistically significant difference between two groups with post treatment IKDC activity level (p < 0.01). Intense activity after treatment rate of patient who had AT was significantly higher than those had TT. There was statistically significant difference between Cybex extension-flexion 60 measurement and extension 240 measurement of the patients (p < 0.01). KT-1000 arthrometer test results with AT was better than the TT in antero-posterior translation of the knee kinematics at 20 and 30 pound of forces. Return to exercise time of patients who had TT was significantly higher than those had AT (p < 0.01). There was no statistically significant difference between return to work time of patients (p > 0.05).

CONCLUSION

Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics.

Authors+Show Affiliations

Igdir State Hospital Orthopaedics and Traumatology Department, Turkey. Electronic address: dreraykilinc@gmail.com.Istanbul Medipol University Orthopaedics and Traumatology Department, Turkey.Sisli Etfal Training and Research Hospital Orthopaedics and Traumatology Department, Turkey.Zonguldak State Hospital Orthopaedics and Traumatology Department, Turkey.Catalca State Hospital Orthopaedics and Traumatology Department, Turkey.İzmir Tepecik Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.Erzurum Training and Research Hospital, Sports Medicine, Turkey.Istanbul Medical Faculty, Sports Medicine, Turkey.Sisli Etfal Training and Research Hospital Orthopaedics and Traumatology Department, Turkey.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26987514

Citation

Kilinc, Bekir Eray, et al. "Transtibial Vs Anatomical Single Bundle Technique for Anterior Cruciate Ligament Reconstruction: a Retrospective Cohort Study." International Journal of Surgery (London, England), vol. 29, 2016, pp. 62-9.
Kilinc BE, Kara A, Oc Y, et al. Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A Retrospective Cohort Study. Int J Surg. 2016;29:62-9.
Kilinc, B. E., Kara, A., Oc, Y., Celik, H., Camur, S., Bilgin, E., ... Eren, O. T. (2016). Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A Retrospective Cohort Study. International Journal of Surgery (London, England), 29, pp. 62-9. doi:10.1016/j.ijsu.2016.03.025.
Kilinc BE, et al. Transtibial Vs Anatomical Single Bundle Technique for Anterior Cruciate Ligament Reconstruction: a Retrospective Cohort Study. Int J Surg. 2016;29:62-9. PubMed PMID: 26987514.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A Retrospective Cohort Study. AU - Kilinc,Bekir Eray, AU - Kara,Adnan, AU - Oc,Yunus, AU - Celik,Haluk, AU - Camur,Savas, AU - Bilgin,Emre, AU - Erten,Yunus Turgay, AU - Sahinkaya,Turker, AU - Eren,Osman Tugrul, Y1 - 2016/03/14/ PY - 2015/11/21/received PY - 2016/03/08/revised PY - 2016/03/10/accepted PY - 2016/3/19/entrez PY - 2016/3/19/pubmed PY - 2017/3/24/medline KW - Anatomical single-bundle technique KW - Anterior cruciate ligament KW - Transtibial technique SP - 62 EP - 9 JF - International journal of surgery (London, England) JO - Int J Surg VL - 29 N2 - INTRODUCTION: Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT). MATERIAL METHOD: Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 ± 6, and 27.9 ± 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60°/sec, 240°/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis. RESULT: There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p < 0.01). Lysholm Activity level of patients who had AT significantly higher than TT. There was no statistically significant difference between Modified Cincinnati activity level of the patients (p < 0.05). Modified Cincinnati activity level of patients who had AT were significantly higher than those had TT. There was no statistically significant difference between two groups with post treatment IKDC activity level (p < 0.01). Intense activity after treatment rate of patient who had AT was significantly higher than those had TT. There was statistically significant difference between Cybex extension-flexion 60 measurement and extension 240 measurement of the patients (p < 0.01). KT-1000 arthrometer test results with AT was better than the TT in antero-posterior translation of the knee kinematics at 20 and 30 pound of forces. Return to exercise time of patients who had TT was significantly higher than those had AT (p < 0.01). There was no statistically significant difference between return to work time of patients (p > 0.05). CONCLUSION: Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics. SN - 1743-9159 UR - https://www.unboundmedicine.com/medline/citation/26987514/Transtibial_vs_anatomical_single_bundle_technique_for_anterior_cruciate_ligament_reconstruction:_A_Retrospective_Cohort_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1743-9191(16)00242-9 DB - PRIME DP - Unbound Medicine ER -