Outcome of Single-Bundle Hamstring Anterior Cruciate Ligament Reconstruction Using the Anteromedial Versus the Transtibial Technique: A Systematic Review and Meta-analysis.
OBJECTIVE
To compare the clinical outcomes of single-bundle hamstring anterior cruciate ligament (ACL) reconstruction between the anteromedial (AM) and transtibial (TT) techniques.


METHODS
We performed a comprehensive systematic review and meta-analysis of the English-language literature in the PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials databases for articles that compared clinical outcomes of AM versus TT ACL reconstruction. The outcome measures analyzed included postoperative Lachman test, pivot-shift test, International Knee Documentation Committee (IKDC), and Lysholm scores.


RESULTS
We included 10 articles from an initial 308 abstracts for the systematic review and included 6 studies for the meta-analysis. The study population consisted of a total of 733 patients, of whom 366 (49.9%) underwent the AM technique and 367 (50.1%) underwent the TT technique for ACL reconstruction. For postoperative knee stability, the AM technique yielded superior results in terms of the proportion of negative Lachman test results (n = 243; odds ratio [OR], 2.98 [95% confidence interval (CI), 1.29 to 6.88]) and proportion of negative pivot-shift test results (n = 238; OR, 3.67 [95% CI, 1.80 to 7.52]). For postoperative functional status, the AM technique yielded superior results in terms of objective IKDC grading (proportion with IKDC grade A) (n = 269; OR, 2.19 [95% CI, 1.23 to 3.88]) but had comparable Lysholm scores (n = 478; mean difference, 1.43 [95% CI, 0.01 to 2.84]).


CONCLUSIONS
Single-bundle hamstring ACL reconstruction using the AM technique showed superior surgeon-recorded stability according to the IKDC knee score, Lachman test, and pivot-shift test. However, there was no difference in patient-reported functional outcome (Lysholm score).


METHODS
Level III, systematic review and meta-analysis of Level I, II, and III studies.
Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Yongsheng
Y
Chen
Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore. Electronic address: zackary_kh_chua@nuhs.edu.sg.
Kerk Hsiang Zackary
KH
Chua
Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Amritpal
A
Singh
Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Jun Hao
JH
Tan
Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Xi
X
Chen
Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore.
Shi Hui
SH
Tan
Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore.
Bee Choo
BC
Tai
Division of Sports Medicine and Surgery, Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore.
Krishna
K
Lingaraj
D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D013977:Tibia / Q000601:surgery*