This cohort study was based on data from a single surgeon’s registry. the transtibial group (37 vs. 25). Bla on productions www.blazonproductions.com poster exhibit designed by LLC SPORTS MEDICINE CENTER A number of studies suggest improved biomechanical and clinical results when ACL grafts are placed anatomically. "One concern with the anteromedial portal technique is the potential to overconstrain or overtighten the joint, and many feel that it is better to be on the looser side than the too-tight side because of the risk of being excessively tight, resulting in arthritic change within the joint," Dr. Black noted. This website also contains material copyrighted by 3rd parties. 0000008125 00000 n Measure the position of the end of the K wire using the quadrant method ( Fig. 0000003851 00000 n 0000093963 00000 n Although the improved reproduction of the ACL anatomy was expected with the anteromedial approach, the findings of the significant aperture expansion of the tibial tunnel that occurred with the transtibial technique were a surprise, Dr. Bedi said. We also hypothesized that anteromedial portal ACL reconstruction would result Jonathan Kelsie Jennings , MD, 1 Daniel Leas , MD, 2 James E. Fleischli , MD, 1 Donald D’Alessandro , MD, 1 Richard Dennis Peindl , PhD, 2 … Thus one can choose the desired placement of the femoral tunnel without considering the placement of the tibial tunnel. This text not only provides a solid foundation in basic and applied science, it also serves as a superb study source for sports certification exams and provides practical therapeutic advice. Kevin P. Black, MD, professor and C. McCollister Evarts Chair of the Bone & Joint Institute at the Penn State Milton S. Hershey Medical Center in Pennsylvania and a moderator at the presentation, applauded the study, but felt that more clinical studies will be needed before he would be convinced to shift from the transtibial technique. "We found that the tibial tunnel is inadvertently re-reamed when preparing the 'best possible' femoral socket with the transtibial technique, resulting in as much as 40% enlargement of the tibial tunnel on the day of surgery.". 0000029673 00000 n 0000027007 00000 n Found insideWang H, Fleischli JE, Zheng N. Transtibial versus anteromedial portal technique in singlebundle anterior cruciate ligament reconstruction: outcomes of knee joint kinematics during walking. Am J Sports Med. 2013;41(8):1847–1856. 16. 0000024190 00000 n Arthroscopic ACL reconstruction is the current standard care of treatment for anterior cruciate ligament (ACL) injuries. 42.2 ). Transtibial Versus Anteromedial Portal ACL Reconstruction Can A Hybrid Approach Achieve The Best Of Both? … American Orthopaedic Society for Sports Medicine (AOSSM) 35th Annual Meeting: Abstract 8358. This article outlines the surgical technique for an anteromedial portal ACL reconstruction with a tibialis anterior allograft fixed with the Mitek Femoral and Tibial Intrafix sheath and screw system (DePuy Synthes, Raynham, MA). Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA. 0000114216 00000 n Burnout Might Really Be Depression; How Do Doctors Cope? 0000114547 00000 n Purpose: Making the femoral tunnel through the anteromedial (AM) portal is believed to allow an unconstrained position compared with the traditional transtibial (TT) tunnel. 0000113088 00000 n Level of evidence Case series, Level IV. To compare the 2 approaches, the researchers evaluated 10 cadaveric knees that were randomized for ACL reconstruction using either a transtibial or anteromedial portal technique. This report respectively compared the standard transtibial (sTT) technique to the independent drilling (ID) techniques applied to anterior cruciate ligament (ACL) reconstruction. Autograft vs. Allograft? If you are certain that the guidewire is in the correct position, overdrill the guidewire with a reamer in the chosen depth. %PDF-1.4 %���� 42.6 ). 0000002411 00000 n 0000114317 00000 n Each physician has his or her own preferred technique, but is one more superior to the others? Methods: This cohort study was based on data from a single surgeon’s registry. ACL reconstruction using the medial portal technique is facilitated by using three arthroscopic portals (Figure 3): • The anterolateral (AL) portal, used as a viewing portal to perform diagnostic arthroscopy and meniscal surgery • The anteromedial (AM) portal, used as both a working and viewing portal •The accessory anteromedial Mean Lysholm score was 78.32±10.7 in the transtibial group and ... Anterior cruciate ligament reconstruction using either the transtibial or transportal TransFix ... U-guide is inserted through the anteromedial portal. Artificial ligaments are also discussed since they are still used in Europe and Asia. This book summarizes the pros and cons of each graft option in detail. Dr. Bedi and Dr. Black have disclosed no relevant financial relationships. However, 7 of 36 tunnels (19.4%) showed violation of the posterior tunnel wall, and all of these cases occurred … Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. 0000003963 00000 n 0000047350 00000 n Transtibial Versus Anteromedial Portal ACL Reconstruction. Share cases and questions with Physicians on Medscape Consult. Anatomic Anterior Cruciate Ligament Reconstruction via Independent Tunnel Drilling: A Systematic ... including outside-in and anteromedial portal techniques, for both autografts were eligible for inclusion, ... actually be higher with anatomic ACL reconstruction than traditional transtibial techniques.27-30 It … 0000031244 00000 n Introduce a femoral guide (6-mm offset for an 8-mm hamstring graft or 7-mm offset for a 10-mm BPTB graft) through the medial portal. The correct placement of the femoral tunnel is very essential for the success of the anterior cruciate ligament (ACL) reconstruction. Transtibial (TT) and hybrid transtibial (HTT) differed by roughly 8 , while anteromedial (AM) portal femoral tunnels were 20 to 30 more angulated (relative to a straight line trajectory). Knee Surg Sports TraumatolArthrosc.1998;6:S2–12. 0000029532 00000 n However, no studies have investigated whether the anteromedial approach results in better outcomes compared to the traditional transtibial drilling approach when a hamstring … Please enter a Recipient Address and/or check the Send me a copy checkbox. hygtSW���꒢���V� Review Clinical and Radiological Outcomes of Anteromedial Portal Versus Transtibial Technique in ACL Reconstruction A Systematic Review Marios Loucas,* MD, Rafael Loucas,* MD, Riccardo D’Ambrosi,† MD, and Michael Elias Hantes,‡§ MD, PhD Investigation performed at the Department of Orthopedic Surgery, Faculty of Medicine, 0000005874 00000 n al. 0000057713 00000 n Am J Sports Med. The posterior margin of the notch must be clearly identified to ensure an over-the-top position. Found inside – Page 14A potential advantage to this technique was highlighted by a study comparing femoral tunnel size following transtibial and anteromedial portal drilling techniques. Chhabra et al40 found greater femoral tunnel expansion in the ... Purpose: Making the femoral tunnel through the anteromedial (AM) portal is believed to allow an unconstrained position compared with the traditional transtibial (TT) tunnel. Found inside – Page 237Transtibial versus anteromedial portal technique in single-bundle anterior cruciate ligament reconstruction: outcomes of knee joint kinematics during walking. Am J Sports Med. 2013;41(8):1847–56.doi:10.1177/0363546513490663. 51. 0000003625 00000 n Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. 0000003738 00000 n Modified transtibial (mTT) and anteromedial portal (AMP) techniques aim at the anatomical placement of femoral tunnel. Found inside – Page 89Arthroscopy 31:1412–1417 Youm YS, Cho SD, Lee SH, Youn CH (2014) Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and ... 0000002243 00000 n Found inside – Page 234Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy. 2011;27: 380–90. Cain EL, Clancy WG. Anatomic endoscopic anterior ... Found inside – Page 850Bedi A, Musahl V, Steuber V, et al. Transtibial Versus Anteromedial Portal Reaming in Anterior Cruciate Ligament Reconstruction: An Anatomic and Biomechanical Evaluation of Surgical Technique. Arthroscopy. 2010. 5. Knee Surg Sports TraumatolArthrosc.1998;6:S2–12. Anatomical anterior cruciate ligament (ACL) reconstruction is a reasonable transition from isometric ACL reconstruction to obtain better clinical outcomes, and most authors believe that it can only be performed through the medial portal technique. Dr. Bedi's study did not receive commercial support. Tasdemir Z., Gulabi D., Ozal S. T., Saglam F., Nurzat Elmalı (2015) Is there any clinical superiority of the anteromedial portal compared to the transtibial in anterior cruciate ligament reconstruction in non-professional athlete patients in short term follow-ups?. Found inside – Page 1426Scientists discuss in 'Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up' new findings in orthopedics. According to recent research from ... Resect the ligamentum mucosum and, if needed, pieces of infrapatellar fat for better visualization. This book provides detailed guidance on knee arthroscopy that reflects the very latest advances in this ever-changing field. Transtibial Versus Anteromedial Portal ACL Reconstruction. If you are not sure about the correct position, the placement of the guidewire should be controlled fluoroscopically (recommended for all arthroscopic procedures ) as follows: Change the drilling machine and fix it at that end of the wire that exits through the skin. The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. The surgical technique continues to evolve and many issues are still under debate. The procedure is usually performed by arthroscopic surgery. This book is a comprehensive guide to ACL surgery for practising orthopaedic surgeons. 0000032701 00000 n %%EOF 0000028812 00000 n Single bundle vs. double bundle? If you log out, you will be required to enter your username and password the next time you visit. To compare the 2 approaches, the researchers evaluated 10 cadaveric knees that were randomized for ACL reconstruction using either a transtibial or anteromedial portal technique. The transtibial drilling of the femoral tunnel has been very much popularized because of its simplicity and good visualization. The femoral tunnel is most commonly made via a transtibial or separate anteromedial portal approach. “The literature [has] shown that the low accessory anteromedial portal is the way to go,” Sgaglione said. 0000106599 00000 n 0000113688 00000 n The Anterior Cruciate Ligament: Reconstruction and Basic Science, 2nd Edition, by Dr. Chadwick Prodromos, provides the expert guidance you need to effectively select the right procedure and equipment, prevent complications, and improve ... Crossref 0000025360 00000 n However, there is evidence that drilling the femoral tunnel through the tibial tunnel can result in a nonanatomical placement of the … A femoral bone tunnel in ACL reconstruction can be constructed from the outside in or from the inside out. Overdrill the K wire if its position is correct; if not, replace the K wire and repeat the fluoroscopy ( Fig. “[We] want more anatomic femoral footprints.” He cited an MRI study by Abebe and colleagues which showed that the independent "A nonanatomic ACL reconstruction resulting from malpositioned tunnels (which can occur with transtibial drilling) is inferior in its ability to restore stability to the knee in the competitive athlete, and is at a higher risk for functional failure," said Dr. Bedi. 0000113804 00000 n Anatomic single bundle anterior cruciate ligament reconstruction by the two anteromedial portal method: the comparison of transportal and transtibial techniques. 2013 Congress Symposium Video Not yet rated <<71B4265AAD885945A6D72AE66742729A>]/Prev 213856>> Analysis of variance and Tukey's test were used to perform statistical analyses, and P < .05 was defined as significant. 0000003062 00000 n 0000034199 00000 n The HTT technique avoids hyperflexion and maintains femoral tunnel orientation and length, similar to the TT technique, but simultaneously achieves anatomic graft positioning. �a����&����S���RMxLt9�Ew%-�����l��ƙ[��0�a�.>,Ȑ�e�����D� ���L�� iV�g�@�DLgu����;倴 �G m��̚ �5��t The mean interval (±SD) for the transtibial group was 8.3±5.0 months. 2014;42(12):2941-7. 10. 0000094017 00000 n 0000006858 00000 n The center of the anterior cruciate ligament insertion is located in the distal corner of the most superoposterior quadrant, Example of different K wire positions in true lateral projection, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on The Anteromedial Portal for Anterior Cruciate Ligament Reconstruction, Three-Portal Technique for Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction, Arthrex TightRope Fixation of a Soft Tissue Graft, Posterior Mini-Incision Hamstring Harvest Approach for Anterior Cruciate Ligament Reconstruction, Transtibial Tunnel Drilling of the Femoral Tunnel for Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction, The Use of CO 2Instead of Fluid in Arthroscopic Anterior Cruciate Ligament Reconstruction, Description of the Direct Femoral Attachment of the Anterior Cruciate Ligament: Implication for Femoral Tunnel Placement in Reconstruction, Anterior Cruciate Ligament Reconstruction with the Use of Femoral INTRAFIX: Rationale, Procedure, and Pearls for a Novel Anterior Cruciate Ligament Fixation Technique to Achieve Anatomical Single-Tunnel Reconstruction, Computer-Assisted Navigation for Anterior Cruciate Ligament Reconstruction, The Anterior Cruciate Ligament: Reconstruction and Basic Science.
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