Comparison of the anatomic femoral and the transtibial tunnel technique in the arthroscopic anterior cruciate ligament reconstruction

Aim: In this study, we aimed to compare the functional results of the transtibial tunnel (TT) and anatomic femoral tunnel (AFT) technique in arthroscopic single -bundle anterior cruciate ligament reconstruction.Material and Methods: We performed arthroscopic single-bundle anterior cruciate ligament reconstruction with autogenous hamstring tendons in 40 patients using the transtibial tunnel technique and 43 patients using the anatomic femoral tunnel technique. We used radiological X-Ray and MR imaging. We evaluated patients on physical examination before and after surgery using Anterior-drawer, Lachman and Pivot-shift tests and Tegner, Lysholm and International Knee Documentation Committee (IKDC) functional scoring systems. Results: Among the patients included in the study, 95.2% (n = 79) were male and 4.8% (n = 4) were female. The mean age of the patients was 30,4 years. In fifty (59.5%) patients, the right knee was affected, in thirty-three (40.5%) patients, the left knee was affected. We followed our patients for an average of 18.9 months. Tegner, Lysholm and IKDC scores are similar in both techniques before and after the surgery. Compared to pre-surgery, significant improvement was observed in the Anterior drawer and Lachman tests of the patients in whom we used the anatomical femoral tunnel technique, while no significant difference was found between the two techniques in the Pivot shift test.Discussion: The location of the tunnels is one of the most important factors affecting the outcome of the ACL reconstruction. The TT technique is an easier and shorter surgical method. In the TT technique, the location of the tibial tunnel determines the placement of the femoral tunnel. Surgical and learning times are longer in the AFT technique. In the AFT technique, the femoral tunnel is drilled independently of the tibial tunnel position, which makes it possible to place the graft in the center of the femoral footprint. Although both techniques show similar functional results, the AFT technique significantly increases anteroposterior and rotational stability. Accordingly, rehabilitation and return to sports are earlier in the anatomic femoral tunnel technique. It is possible to say that the anatomic femoral tunnel technique is superior, considering the patient satisfaction and the rate of returning to the pre-surgical activity level.