Dataset Information

All-Inside Double-Bundle Anterior Cruciate Ligament Reconstruction via the Transtibial Approach With a Laser-Tip Guide System for Drilling.

ABSTRACT: Anterior cruciate ligament reconstruction using an all-inside method to reduce bone damage caused by drill hole preparation and enhance the stability of the reconstructed ligament in the drill hole has been reported in recent years. We made a custom-designed drill guide pin and reamer, which are assembled in the joint, to create drill holes in the femur and tibia. For the transtibial method, our femoral drill hole-positioning technique, which uses a laser, is extremely convenient for accurate positioning of the drill holes. Therefore, a combination of these methods facilitates implementation of the all-inside double-bundle anterior cruciate ligament reconstruction technique.

SUBMITTER: Takahashi T

PROVIDER: S-EPMC6715831 | biostudies-other | 2019 Jul

REPOSITORIES: biostudies-other

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All-Inside Double-Bundle Anterior Cruciate Ligament Reconstruction via the Transtibial Approach With a Laser-Tip Guide System for Drilling.

Takahashi Toshiaki T Watanabe Seiji S Miura Hiromasa H

Arthroscopy techniques 20190717 7

Anterior cruciate ligament reconstruction using an all-inside method to reduce bone damage caused by drill hole preparation and enhance the stability of the reconstructed ligament in the drill hole has been reported in recent years. We made a custom-designed drill guide pin and reamer, which are assembled in the joint, to create drill holes in the femur and tibia. For the transtibial method, our femoral drill hole-positioning technique, which uses a laser, is extremely convenient for accurate po ...[more]

PMID: 31485403

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Project description:BackgroundAnterior cruciate ligament (ACL) reconstruction can be performed with different techniques for independent and transtibial (TT) drilling of femoral tunnels, but there is still no consensus on which approach leads to the best outcome.PurposeTo assess whether the independent or TT drilling approach for ACL reconstruction leads to the best functional outcomes.Study designSystematic review; Level of evidence, 2.MethodsA systematic literature search was conducted on July 1, 2020, using the PubMed, Web of Science, Cochrane Library, and Scopus databases. The influence of different femoral drilling techniques was analyzed through a meta-analysis in terms of patient-reported outcome measure scores, risk of complications, range of motion limitations, graft failure, and differential laxity. Subanalyses were performed to compare the different independent drilling techniques considered. Linear metaregression was performed to evaluate if the year of study publication influenced the results. The risk of bias and quality of evidence were assessed following the Cochrane guidelines.ResultsA total of 22 randomized controlled trials including 1658 patients were included in the meta-analysis. Both International Knee Documentation Committee (IKDC) subjective score and Lysholm score were higher with the independent drilling approach (mean difference [MD], 1.24 [P = .02] and 0.55 [P = .005], respectively). No difference was documented in terms of the risk of reinjury, but independent drilling led to reduced KT-1000 arthrometer-assessed anterior tibial translation (MD, 0.23; P = .01) and a higher probability of a negative postoperative pivot-shift test finding (risk ratio, 1.13; P = .04). There were no significant differences in IKDC objective or Tegner scores. A P value of .07 was found for the association between the year of the study and IKDC objective scores.ConclusionIndependent femoral tunnel drilling provided better results than the TT approach, although the difference was not clinically significant. No difference was observed in the risk of reinjury. Increasingly better results were seen among surgical procedures performed in more recent years. Among the independent drilling options, the anteromedial portal technique seemed to provide the most favorable outcomes. The lack of clinically significant differences and the promising outcomes reported with new modified TT techniques suggest the importance of correct placement, rather than the tunnel drilling approach, to optimize the results of ACL reconstruction.

Project description:PurposeTo evaluate the femoral and tibial tunnel positions via a modified anatomic transtibial double-bundle anterior cruciate ligament (ACL) reconstruction.MethodsPatients who underwent double-bundle ACL reconstruction using the transtibial tunnel creation technique were identified. Double-bundle ACL reconstruction was performed for 94 knees using the transtibial tunnel creation technique. Tunnel aperture configurations and center positions of the anteromedial (AM) and posterolateral (PL) tunnels via postoperative 3-dimensional computed tomography were evaluated.ResultsThere were 94 knees included. Regarding the intra-articular tunnel aperture configurations, the AM and PL tunnels overlapped at the femoral and tibial aperture in 66.0% and 94.7% cases, respectively. The mean femoral bone tunnel center was located at 23.0 ± 3.9% in the posterior-to-anterior ratio and 28.7 ± 6.0% in the proximal-to-distal ratio for the AM tunnels and at 32.8 ± 4.7% and 51.2 ± 5.2% for the PL tunnels, respectively. In the tibial tunnels, the mean AM tunnel center was located at 31.4 ± 3.6% in the anterior-to-posterior ratio and 44.3 ± 1.8% in the medial-to-lateral ratio and at 47.5 ± 3.8% and 44.3 ± 1.9% in the PL tunnel center, respectively. The femoral tunnels of outliers, both those created in nonanatomic positions as well as the posterior wall blowouts, were revealed in 7.4% cases. The nonanatomical bone tunnel group had significant heavier weight patients, lower tibial posterior slope, and were anterior in the AM and PL tunnel position. Posterior wall blowouts were related to posterior and proximal PL bone tunnel positions.ConclusionsModified transtibial double-bundle ACL reconstruction is a reliable tunnel creation technique with anatomic placement in 92.6% of the cases. The modification required that partially superimposing configuration of the 2 tibial tunnel apertures. The nonanatomic tunnels were related to patients of heavier weight and lower tibial posterior sloped knees, whereas the posterior wall blowouts were related to the posterior and proximal PL bone tunnel positions.Level of evidenceLevel IV, therapeutic case series.

Dataset Information

All-Inside Double-Bundle Anterior Cruciate Ligament Reconstruction via the Transtibial Approach With a Laser-Tip Guide System for Drilling.

Publications

All-Inside Double-Bundle Anterior Cruciate Ligament Reconstruction via the Transtibial Approach With a Laser-Tip Guide System for Drilling.

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