No Difference in 10- to 14-Year Outcomes After Modified Transtibial Versus Anteromedial Portal Techniques in Anterior Cruciate Ligament Reconstruction.

Purpose: To compare the long-term clinical and radiological outcomes of modified transtibial and anteromedial portal techniques in single-bundle anterior cruciate ligament (ACL) reconstruction to provide more comprehensive guidance for treatment. Methods: This study included patients who underwent arthroscopic single-bundle ACL reconstruction with adequate follow-up between January 2010 and December 2014. Patients were grouped according to the surgical techniques used: those who underwent the modified transtibial technique (group 1) and those who underwent the anteromedial portal technique (group 2). Clinical assessments included the 2000 International Knee Documentation Committee subjective knee score, Lysholm knee score, Tegner activity scale, Hospital for Special Surgery Knee score, Lachman test, and pivot-shift test. Radiological evaluations assessed the femoral tunnel's location and length, as well as the inclination angles in the coronal, sagittal, and axial planes through computed tomography scans, while the graft bending angle and ligament maturity were evaluated via magnetic resonance imaging. Results: A total of 73 patients were included: 36 in group 1 and 37 in group 2. No clinically significant differences were observed between the 2 techniques in the International Knee Documentation Committee score (mean difference [MD], 2.7; 95% confidence interval [CI], -1.5 to 6.9; minimal clinically important difference [MCID], 13.8), Lysholm score (MD, -0.1; 95% CI, -5.0 to 4.8; MCID, 8.9), Tegner score (MD, 0.6; 95% CI, -0.3 to 1.5; MCID, 1), and Hospital for Special Surgery Knee score (MD, 3.0; 95% CI, 0.3 to 5.7; MCID, 5.4). However, significant differences were noted in the mean distances from the femoral tunnel center to the posterior condylar surface (36.77% ± 4.60% in group 1 vs 32.14% ± 5.21% in group 2; P < .001) and to the Blumensaat line (24.34% ± 4.36% vs 30.02% ± 6.44%; P < .001). The inclination angles of the femoral tunnel differed significantly between the 2 groups in the coronal plane (55.21° ± 6.10° vs 35.79° ± 8.79°; P < .001), sagittal plane (27.80° ± 8.26° vs 40.06° ± 9.29°; P < .001), and axial plane (43.21° ± 7.21° vs 31.21° ± 8.36°; P < .001). Compared with group 2, group 1 presented a significantly greater femoral tunnel length (38.63 ± 4.33 vs 33.97 ± 2.65; P < .001). Furthermore, the graft bending angle in group 1 was significantly smaller than that in group 2 (26.62° ± 7.49° vs 36.92° ± 5.92°; P < .001). There was no statistically significant difference in graft maturity between the 2 groups (5.32 ± 3.52 vs 4.82 ± 2.91; P = .544). Conclusions: The modified transtibial and anteromedial portal techniques for ACL reconstruction achieved comparable clinical outcomes. Despite some differences in femoral tunnel placement, there are no significant differences in long-term clinical results. Level of Evidence: III, Retrospective cohort study.