title: Comparison of femur tunnel aperture location in patients undergoing transtibial and anatomical single-bundle anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  Although three-dimensional computed tomography (3D-CT) has been used to compare femoral tunnel position following transtibial and anatomical anterior cruciate ligament (ACL) reconstruction, no consensus has been reached on which technique results in a more anatomical position because methods of quantifying femoral tunnel position on 3D-CT have not been consistent. This meta-analysis was therefore performed to compare femoral tunnel location following transtibial and anatomical ACL reconstruction, in both the low-to-high and deep-to-shallow directions.
  
  
  METHODS
  This meta-analysis included all studies that used 3D-CT to compare femoral tunnel location, using quadrant or anatomical coordinate axis methods, following transtibial and anatomical (AM portal or OI) single-bundle ACL reconstruction.
  
  
  RESULTS
  Six studies were included in the meta-analysis. Femoral tunnel location was 18 % higher in the low-to-high direction, but was not significant in the deep-to-shallow direction, using the transtibial technique than the anatomical methods, when measured using the anatomical coordinate axis method. When measured using the quadrant method, however, femoral tunnel positions were significantly higher (21 %) and shallower (6 %) with transtibial than anatomical methods of ACL reconstruction.
  
  
  CONCLUSIONS
  The anatomical ACL reconstruction techniques led to a lower femoral tunnel aperture location than the transtibial technique, suggesting the superiority of anatomical techniques for creating new femoral tunnels during revision ACL reconstruction in femoral tunnel aperture location in the low-to-high direction. However, the mean difference in the deep-to-shallow direction differed by method of measurement.
  
  
  METHODS
  Meta-analysis, Level II.
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyeong-Sik
authors.initials: HS
authors.lastname: Ahn
authors.affiliation: Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, 388-1, Poongnap-2dong, Songpa-gu, Seoul, 138-736, Korea. sibin@amc.seoul.kr.
authors.forename: Seong-Il
authors.initials: SI
authors.lastname: Bin
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy / Q000379:methods*; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: 3D-CT; Anterior cruciate ligament reconstruction; Anteromedial portal; Meta-analysis; Outside-in; Transtibial