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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 5/2012

01.05.2012 | Knee

ACL reconstruction: comparison between transtibial and anteromedial portal techniques

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 5/2012

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Abstract

Purpose

The purpose of this study was to compare the transtibial reconstruction technique of the anterior cruciate ligament (ACL) with the anteromedial (AM) portal technique in their ability to place the femoral and tibial tunnels within the ACL footprints.

Methods

Forty patients were sequentially enrolled in two different surgical techniques, 20 patients in the transtibial and 20 patients in the AM portal technique. All patients underwent computed tomography scan of the operated knee. The center of the femoral tunnel aperture on the lateral femoral condyle was measured according to the quadrant method. On the tibial side, the center of the tibial tunnel was measured in the sagittal plane. These measurements were compared with the center of the normal AM and PL bundles.

Results

There were no differences in the center of the femoral tunnels on the Blumensaat’s line between the two groups (mean 23.5% (4.2) for the transtibial technique and 26.0% (4.3) for the AM portal technique (P = n.s.). In the height of the femoral condyle, the center of the tunnels was significantly lower in the AM portal technique group [mean 34.7% (3.8) vs. 24.0% (7.9) (P < 0.001)]. In the tibia, the center of the tunnel in the sagittal plane was significantly posterior in the transtibial technique (mean 55.4% (4.9) vs. 44.4% (3.7) (P < 0.001).

Conclusions

The AM portal technique places the femoral and tibial tunnels more centrally in the ACL footprint when compared with the transtibial technique.

Level of evidence

II.
Literatur
1.
Zurück zum Zitat Abebe ES, Moorman CT 3rd, Dziedzic TS, Spritzer CE, Cothran RL, Taylor DC, Garrett WE Jr, DeFrate LE (2009) Femoral tunnel place-ment during anterior cruciate ligament reconstruction: an in vivo imaging analysis comparing transtibial and 2-incision tibial tunnel–independent techniques. Am J Sports Med 37:1904–1911PubMedCrossRef Abebe ES, Moorman CT 3rd, Dziedzic TS, Spritzer CE, Cothran RL, Taylor DC, Garrett WE Jr, DeFrate LE (2009) Femoral tunnel place-ment during anterior cruciate ligament reconstruction: an in vivo imaging analysis comparing transtibial and 2-incision tibial tunnel–independent techniques. Am J Sports Med 37:1904–1911PubMedCrossRef
2.
Zurück zum Zitat Aglietti P, Zaccherotti G, Menchetti PP, De Biase P (1995) A comparison of clinical and radiological parameters with two arthroscopic techniques for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 3:2–8PubMedCrossRef Aglietti P, Zaccherotti G, Menchetti PP, De Biase P (1995) A comparison of clinical and radiological parameters with two arthroscopic techniques for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 3:2–8PubMedCrossRef
3.
Zurück zum Zitat Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29:272–279PubMed Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29:272–279PubMed
4.
Zurück zum Zitat Andriacchi TP, Briant PL, Bevill SL, Koo S (2006) Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res 442:39–44PubMedCrossRef Andriacchi TP, Briant PL, Bevill SL, Koo S (2006) Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res 442:39–44PubMedCrossRef
5.
Zurück zum Zitat Arnold MP, Kooloos J, van Kampen A (2001) Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 9:194–199PubMed Arnold MP, Kooloos J, van Kampen A (2001) Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 9:194–199PubMed
6.
Zurück zum Zitat Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Fourstrand hamstring tendon autograft compared with patellar tendonbone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29:722–728PubMed Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Fourstrand hamstring tendon autograft compared with patellar tendonbone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29:722–728PubMed
7.
Zurück zum Zitat Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27:380–390PubMedCrossRef Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW (2011) Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 27:380–390PubMedCrossRef
8.
Zurück zum Zitat Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL: radiographic quadrant method. Am J Knee Surg 10:14–21PubMed Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL: radiographic quadrant method. Am J Knee Surg 10:14–21PubMed
9.
Zurück zum Zitat Cain EL Jr, Clancy WG Jr (2002) Anatomic endoscopic anterior cruciate ligament reconstruction with patella tendon autograft. Orthop Clin North Am 33:717–725PubMedCrossRef Cain EL Jr, Clancy WG Jr (2002) Anatomic endoscopic anterior cruciate ligament reconstruction with patella tendon autograft. Orthop Clin North Am 33:717–725PubMedCrossRef
10.
Zurück zum Zitat Chhabra A, Diduch DR, Blessey PB, Miller MD (2004) Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks. Arthroscopy 20:328–330PubMedCrossRef Chhabra A, Diduch DR, Blessey PB, Miller MD (2004) Recreating an acceptable angle of the tibial tunnel in the coronal plane in anterior cruciate ligament reconstruction using external landmarks. Arthroscopy 20:328–330PubMedCrossRef
11.
Zurück zum Zitat Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992PubMedCrossRef Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992PubMedCrossRef
12.
Zurück zum Zitat Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17:220–227PubMedCrossRef Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T (2009) Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 17:220–227PubMedCrossRef
13.
Zurück zum Zitat DeFrate LE, Papannagari R, Gill TJ, Moses JM, Pathare NP, Li G (2006) The 6 degrees of freedom kinematics of the knee after anterior cruciate ligament deficiency: an in vivo imaging analysis. Am J Sports Med 34:1240–1246PubMedCrossRef DeFrate LE, Papannagari R, Gill TJ, Moses JM, Pathare NP, Li G (2006) The 6 degrees of freedom kinematics of the knee after anterior cruciate ligament deficiency: an in vivo imaging analysis. Am J Sports Med 34:1240–1246PubMedCrossRef
14.
Zurück zum Zitat Fetto JF, Marshall JL (1980) The natural history and diagnosis of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:29–38PubMed Fetto JF, Marshall JL (1980) The natural history and diagnosis of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:29–38PubMed
15.
Zurück zum Zitat Fink C, Hoser C, Hackl W, Navarro RA, Benedetto KP (2001) Long-term outcome of operative or nonoperative treatment of anterior cruciate ligament rupture: is sports activity a determining variable? Int J Sports Med 22:304–309PubMedCrossRef Fink C, Hoser C, Hackl W, Navarro RA, Benedetto KP (2001) Long-term outcome of operative or nonoperative treatment of anterior cruciate ligament rupture: is sports activity a determining variable? Int J Sports Med 22:304–309PubMedCrossRef
16.
Zurück zum Zitat Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament injured knee. Am J Sports Med 33:335–346PubMedCrossRef Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D, Daniel DM (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament injured knee. Am J Sports Med 33:335–346PubMedCrossRef
17.
Zurück zum Zitat Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR Jr (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11PubMed Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR Jr (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11PubMed
18.
Zurück zum Zitat Galla M, Uffmann J, Lobenhoffer P (2004) Femoral fixation of hamstring tendon autografts using the TransFix device with additional bone grafting in an anteromedial portal technique. Arch Orthop Trauma Surg 124:281–284PubMedCrossRef Galla M, Uffmann J, Lobenhoffer P (2004) Femoral fixation of hamstring tendon autografts using the TransFix device with additional bone grafting in an anteromedial portal technique. Arch Orthop Trauma Surg 124:281–284PubMedCrossRef
19.
Zurück zum Zitat Georgoulis AD, Papadonikolakis A, Papageorgiou CD, Mitsou A, Stergiou N (2003) Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking. Am J Sports Med 31:75–79PubMed Georgoulis AD, Papadonikolakis A, Papageorgiou CD, Mitsou A, Stergiou N (2003) Three-dimensional tibiofemoral kinematics of the anterior cruciate ligament-deficient and reconstructed knee during walking. Am J Sports Med 31:75–79PubMed
20.
Zurück zum Zitat Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD (2007) The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: A cadaveric study. Arthroscopy 23:1187–1192PubMedCrossRef Golish SR, Baumfeld JA, Schoderbek RJ, Miller MD (2007) The effect of femoral tunnel starting position on tunnel length in anterior cruciate ligament reconstruction: A cadaveric study. Arthroscopy 23:1187–1192PubMedCrossRef
21.
Zurück zum Zitat Hantes ME, Dailiana Z, Zachos VC, Varitimidis SE (2006) Anterior cruciate ligament reconstruction using the Bio-TransFix femoral fixation device and anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 14:497–501PubMedCrossRef Hantes ME, Dailiana Z, Zachos VC, Varitimidis SE (2006) Anterior cruciate ligament reconstruction using the Bio-TransFix femoral fixation device and anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 14:497–501PubMedCrossRef
22.
Zurück zum Zitat Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:464–472PubMedCrossRef Ho JY, Gardiner A, Shah V, Steiner ME (2009) Equal kinematics between central anatomic single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 25:464–472PubMedCrossRef
23.
Zurück zum Zitat Howell SM, Hull ML (2009) Checkpoints for judging tunnel and anterior cruciate ligament graft placement. J Knee Surg 22:161–170PubMedCrossRef Howell SM, Hull ML (2009) Checkpoints for judging tunnel and anterior cruciate ligament graft placement. J Knee Surg 22:161–170PubMedCrossRef
24.
Zurück zum Zitat Kanaya A, Ochi M, Deie M, Adachi N, Nishimori M, Nakamae A (2009) A intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single-bundle versus double-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 17:907–913PubMedCrossRef Kanaya A, Ochi M, Deie M, Adachi N, Nishimori M, Nakamae A (2009) A intraoperative evaluation of anteroposterior and rotational stabilities in anterior cruciate ligament reconstruction: lower femoral tunnel placed single-bundle versus double-bundle reconstruction. Knee Surg Sports Traumatol Arthrosc 17:907–913PubMedCrossRef
25.
Zurück zum Zitat Kato Y, Ingham SJ, Kramer S, Smolinski P, Saito A, Fu FH (2010) Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model. Knee Surg Sports Traumatol Arthrosc 18:2–10PubMedCrossRef Kato Y, Ingham SJ, Kramer S, Smolinski P, Saito A, Fu FH (2010) Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model. Knee Surg Sports Traumatol Arthrosc 18:2–10PubMedCrossRef
26.
Zurück zum Zitat Khalfayan EE, Sharkey PF, Alexander AH, Bruckner JD, Bynum EB (1996) The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med 24:335–341PubMedCrossRef Khalfayan EE, Sharkey PF, Alexander AH, Bruckner JD, Bynum EB (1996) The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med 24:335–341PubMedCrossRef
27.
Zurück zum Zitat Kohn D, Busche T, Carls J (1998) Drill hole position in endoscopic anterior cruciate ligament reconstruction: results of an advanced arthroscopy course. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S13–S15PubMedCrossRef Kohn D, Busche T, Carls J (1998) Drill hole position in endoscopic anterior cruciate ligament reconstruction: results of an advanced arthroscopy course. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S13–S15PubMedCrossRef
28.
Zurück zum Zitat Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL-Y (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19:297–304PubMedCrossRef Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL-Y (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19:297–304PubMedCrossRef
29.
Zurück zum Zitat Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152PubMedCrossRef Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152PubMedCrossRef
30.
Zurück zum Zitat Lorenz S, Elser F, Mitterer M, Obst T, Imhoff AB (2009) Radiologic evaluation of the insertion sites of the 2 functional bundles of the anterior cruciate ligament using 3-dimensional computed tomography. Am J Sports Med 37:2368–2376PubMedCrossRef Lorenz S, Elser F, Mitterer M, Obst T, Imhoff AB (2009) Radiologic evaluation of the insertion sites of the 2 functional bundles of the anterior cruciate ligament using 3-dimensional computed tomography. Am J Sports Med 37:2368–2376PubMedCrossRef
31.
Zurück zum Zitat Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101PubMedCrossRef Lubowitz JH (2009) Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 25:95–101PubMedCrossRef
32.
Zurück zum Zitat Miller CD, Gerdeman AC, Hart JM, Bennett CG, Golish SR, Gaskin C, Miller MD (2011) A comparison of 2 drilling techniques on the femoral tunnel for anterior cruciate ligament reconstruction. Arthroscopy 27:372–379PubMedCrossRef Miller CD, Gerdeman AC, Hart JM, Bennett CG, Golish SR, Gaskin C, Miller MD (2011) A comparison of 2 drilling techniques on the femoral tunnel for anterior cruciate ligament reconstruction. Arthroscopy 27:372–379PubMedCrossRef
33.
Zurück zum Zitat Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33:712–718PubMedCrossRef Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 33:712–718PubMedCrossRef
34.
Zurück zum Zitat Nishimoto K, Kuroda R, Mizuno K, Hoshino Y, Nagamune K, Kubo S, Yagi M, Yamaguchi M, Yoshiya S, Kurosaka M (2009) Analysis of the graft bending angle at the femoral tunnel aperture in anatomic double bundle anterior cruciate ligament reconstruction: a comparison of the transtibial and the far anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 17:270–276PubMedCrossRef Nishimoto K, Kuroda R, Mizuno K, Hoshino Y, Nagamune K, Kubo S, Yagi M, Yamaguchi M, Yoshiya S, Kurosaka M (2009) Analysis of the graft bending angle at the femoral tunnel aperture in anatomic double bundle anterior cruciate ligament reconstruction: a comparison of the transtibial and the far anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc 17:270–276PubMedCrossRef
35.
Zurück zum Zitat Papannagari R, Gill TJ, Defrate LE, Moses JM, Petruska AJ, Li G (2006) In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation. Am J Sports Med 34:2006–2012PubMedCrossRef Papannagari R, Gill TJ, Defrate LE, Moses JM, Petruska AJ, Li G (2006) In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation. Am J Sports Med 34:2006–2012PubMedCrossRef
36.
Zurück zum Zitat Scopp JM, Jasper LE, Belkoff SM, Moorman CT 3rd (2004) The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 20:294–299PubMedCrossRef Scopp JM, Jasper LE, Belkoff SM, Moorman CT 3rd (2004) The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy 20:294–299PubMedCrossRef
37.
Zurück zum Zitat Silva A, Sampaio R, Pinto E (2010) Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1245–1251PubMedCrossRef Silva A, Sampaio R, Pinto E (2010) Placement of femoral tunnel between the AM and PL bundles using a transtibial technique in single-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1245–1251PubMedCrossRef
38.
Zurück zum Zitat Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position: anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146PubMedCrossRef Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position: anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146PubMedCrossRef
39.
Zurück zum Zitat Takahashi M, Doi M, Abe M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34:787–792PubMedCrossRef Takahashi M, Doi M, Abe M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34:787–792PubMedCrossRef
40.
Zurück zum Zitat Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983PubMedCrossRef Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983PubMedCrossRef
41.
Zurück zum Zitat Yamamoto Y, Hsu WH, Woo SL, Van Scyoc AH, Takakura Y, Debski RE (2004) Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Am J Sports Med 32:1825–1832PubMedCrossRef Yamamoto Y, Hsu WH, Woo SL, Van Scyoc AH, Takakura Y, Debski RE (2004) Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Am J Sports Med 32:1825–1832PubMedCrossRef
42.
Zurück zum Zitat Yunes M, Richmond JC, Engels EA, Pinczewski LA (2001) Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy 17:248–257PubMedCrossRef Yunes M, Richmond JC, Engels EA, Pinczewski LA (2001) Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy 17:248–257PubMedCrossRef
43.
Zurück zum Zitat Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, Petersen W (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36:678–685PubMedCrossRef Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, Petersen W (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36:678–685PubMedCrossRef
44.
Zurück zum Zitat Zantop T, Petersen W (2008) Double bundle revision of a malplaced single bundle vertical ACL reconstruction: ACL revision surgery using a two femoral tunnel technique. Arch Orthop Trauma Surg 128:1287–1294PubMedCrossRef Zantop T, Petersen W (2008) Double bundle revision of a malplaced single bundle vertical ACL reconstruction: ACL revision surgery using a two femoral tunnel technique. Arch Orthop Trauma Surg 128:1287–1294PubMedCrossRef
45.
Zurück zum Zitat Zantop T, Wellmann M, Fu FH, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRef Zantop T, Wellmann M, Fu FH, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRef
Metadaten
Titel
ACL reconstruction: comparison between transtibial and anteromedial portal techniques
Publikationsdatum
01.05.2012
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 5/2012
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-011-1645-3

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