title: Clinical and three-dimensional computed tomographic comparison between ACL transportal versus ACL transtibial single-bundle reconstructions with hamstrings.
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) reconstruction using a single-bundle transtibial technique can achieve good or excellent results in more than 90% of patients, but anatomical and biomechanical studies have questioned its ability to restore knee function. The purpose of this study was to evaluate clinical and tomographic results (patient satisfaction, knee function, and tunnel location) of patients who underwent transportal or transtibial single-bundle ACL reconstruction.
  
  
  METHODS
  Seventy-one patients with ACL tears were included. Forty-one patients were treated by the single-bundle transportal technique and 30 patients were treated by the single-bundle transtibial technique. Clinical and tomographic data were analyzed in both groups.
  
  
  RESULTS
  After a minimum of 2-year period, the transportal group showed more patients with normal clinical tests than the transtibial group (Lachman [p=0.037], pivot shift [0.00], anterior drawer [0.002]; and arthrometer [0.002] tests). Regarding CT evaluation, transportal and transtibial groups obtained the following femoral central tunnel location (mean [SD]), as percentage: 30 (6.5) and 4.2 (6.4) in high-low axis; and 30.9 (5.9) and 33.2 (4.6) in the deep-shallow axis. Values in the tibial side were, respectively: 38 (6.5) and 46.0 (6.8) in the anterior-posterior axis; and 47.2 (2.5) and 46.9 (2.1) in the medial-lateral axis.
  
  
  CONCLUSIONS
  CT findings showed that the transportal single-bundle technique positions the ACL tunnel closer to the native ACL footprint in both femur and tibia compared with the transtibial single-bundle technique. Moreover, mild asymptomatic instability and extension deficit were observed more often in the transtibial group.
authors.affiliation: Orthopaedic Department, Universidade Federal de Minas Gerais and Hospital Felício Rocho, Minas Gerais, Brazil. Electronic address: guilhermeorto@gmail.com.
authors.forename: Guilherme Moreira
authors.initials: GM
authors.lastname: de Abreu-e-Silva
authors.affiliation: Orthopaedic Department, Hospital Felício Rocho, Minas Gerais, Brazil.
authors.forename: Daniel Soares
authors.initials: DS
authors.lastname: Baumfeld
authors.affiliation: Orthopaedic Department, Hospital Felício Rocho, Minas Gerais, Brazil.
authors.forename: Elton Luis Ribeiro
authors.initials: EL
authors.lastname: Bueno
authors.affiliation: Radiology Department, Hospital Felício Rocho, Minas Gerais, Brazil.
authors.forename: Rudolf Moreira
authors.initials: RM
authors.lastname: Pfeilsticker
authors.affiliation: Orthopaedic Department, Universidade Federal de Minas Gerais, Brazil.
authors.forename: Marco Antônio Percope
authors.initials: MA
authors.lastname: de Andrade
authors.affiliation: Surgery Department, Universidade Federal de Minas Gerais, Brazil.
authors.forename: Tarcizo Afonso
authors.initials: TA
authors.lastname: Nunes
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000503:physiopathology; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007718:Knee Injuries / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D020127:Recovery of Function; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*; D013848:Thigh; D013977:Tibia / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: ACL reconstruction; Computed tomography; Knee; Transportal; Transtibial