Clinical Comparisons Between the Transtibial Technique and the Far Anteromedial Portal Technique for Posterolateral Femoral Tunnel Drilling in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Purpose: The purpose of this study was to compare the clinical results of the transtibial and far anteromedial portal techniques for posterolateral (PL) femoral tunnel drilling in double-bundle anterior cruciate ligament reconstruction. Methods: This study involved 50 patients who underwent double-bundle anterior cruciate ligament reconstruction and were followed up for more than 2 years. The anteromedial bundle was reconstructed with the far anteromedial portal technique in all patients. However, the PL bundle was reconstructed with the transtibial and far anteromedial portal techniques in 22 patients (group T) and 28 patients (group F), respectively. The follow-up visits included evaluation of Lysholm knee scores, KT-2000 measurement of anterior knee laxity (MEDmetric, San Diego, CA), the pivot-shift test, and radiography. Results: The length of the PL femoral tunnel in group F (32.2 mm) was significantly shorter than that in group T (39.0 mm). Lateral knee radiographs showed that the positions of the EndoButtons (Smith & Nephew Endoscopy, Andover, MA) for the PL bundles were significantly more posterior (12.8 mm) and distal (3.1 mm) in group F than in group T. The mean KT-2000 side-to-side difference in group T (0.9 mm) and group F (0.7 mm) did not significantly differ. In addition, no significant difference was noted between the groups with respect to Lysholm knee scores and the pivot-shift test results. Conclusions: This study showed that the far anteromedial portal technique is as effective as the transtibial technique and results in good restoration of joint stability and knee scores despite shorter femoral tunnel length and inferoposterior position of the EndoButton. Level of Evidence: Level III, retrospective comparative study.