title: Transtibial versus anteromedial portal anterior cruciate ligament reconstruction using soft-tissue graft and expandable fixation.
abstract: OBJECTIVE
  To compare clinical outcomes between transtibial drilling and anteromedial portal techniques for anterior cruciate ligament (ACL) reconstruction using soft-tissue grafts secured with expandable fixation.
  
  
  METHODS
  Patients undergoing soft-tissue ACL reconstruction using expandable fixation between 2007 and 2011 were reviewed for inclusion in this study. Revision ACL cases were excluded. All surgeries were performed by 1 of 2 sports medicine fellowship-trained surgeons (T.S.D., K.D.M.). A total of 128 patients (67 comprising transtibial cohort and 61 comprising anteromedial portal cohort) had a minimum of 24 months' follow-up (mean, 27 months) and met the inclusion criteria. The patients were divided into 2 groups based on the method used for creation of the femoral tunnel. At final follow-up, outcomes were assessed with KT-1000 (MEDmetric, San Diego, CA) measurements, as well as International Knee Documentation Committee, Lysholm, and Tegner scores. Data were screened for normality and skew before use of parametric statistics and were transformed if necessary. Data were analyzed by 1-way analysis of variance with post hoc paired comparisons using the Bonferroni approximation.
  
  
  RESULTS
  No differences in demographic characteristics were observed between the 2 groups. There was no significant difference in postoperative KT-1000 measurements between the 2 cohorts (1.571 ± 0.2275 mm in transtibial cohort [n = 35] and 1.246 ± 0.09249 mm in anteromedial cohort [n = 61], P = .1259). A significant improvement in International Knee Documentation Committee scores was observed in the anteromedial cohort, increasing from 41 ± 16 to 89 ± 7.4 (mean ± SD) (P < .0001). Similar changes were observed for the Lysholm score. There was no significant difference between cohorts for any postoperative scores measured (P > .2).
  
  
  CONCLUSIONS
  Our data show comparable KT-1000 measurements for both anteromedial and transtibial femoral drilling techniques when using a soft-tissue graft with expandable fixation.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: San Diego Arthroscopy and Sports Medicine, San Diego, California, U.S.A.. Electronic address: mary.mulcahey.md@gmail.com.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Mulcahey
authors.affiliation: San Diego Arthroscopy and Sports Medicine, San Diego, California, U.S.A.; Department of Orthopaedic Surgery, University of California, San Diego, San Diego, California, U.S.A.
authors.forename: Tal S
authors.initials: TS
authors.lastname: David
authors.affiliation: Tri-County Orthopedics, Cedar Knolls, New Jersey, U.S.A.
authors.forename: David M
authors.initials: DM
authors.lastname: Epstein
authors.affiliation: NYU Hospital for Joint Diseases, New York, New York, U.S.A.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Alaia
authors.affiliation: Tri-County Orthopedics, Cedar Knolls, New Jersey, U.S.A.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Montgomery
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008022:Ligaments / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D055815:Young Adult