title: Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: A Retrospective Cohort Study.
abstract: BACKGROUND
  Most of the ACL reconstruction is done with isometric single-bundle technique. Traditionally, surgeons were trained to use the transtibial technique (TT) for drilling the femoral tunnel. Our study compared the early postoperative period functional and clinical outcomes of patients who had ACL reconstruction with TT and patients who had ACL reconstruction with anatomical single-bundle technique (AT).
  
  
  METHODS
  Fifty-five patients who had ACL reconstruction and adequate follow-up between January 2010-December 2013 were included the study. Patients were grouped by their surgery technique. 28 patients included into anatomical single-bundle ACL reconstruction surgery group (group 1) and 27 patients were included into transtibial AC reconstruction group (group 2). Average age of patients in group 1 and group 2 was 28.3 ± 6, and 27.9 ± 6.4, respectively. Lachman and Pivot-shift tests were performed to patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. All patients' muscle strength between both extremities were evaluated with Cybex II (Humac) at 60°/sec, 240°/sec frequencies with flexion and extension peak torque. The maximum force values of non-operated knee and the operated knee were compared to each other. Groups were evaluated by using International Knee Documentation Committee (IKDC) knee ligament healing Standard form, IKDC activity scale, modified Lysholm and Cincinnati evaluation forms. Return to work and exercise time of patients were compared. Functional and clinical outcomes of two groups were compared. NCSS 2007 and PASS 2008 Statistical Software programs were used for statistical analysis.
  
  
  RESULTS
  There was no statistically significant difference between Lachman and Pivot-shift results (p > 0.01). Positive value of Pivot-shift test and incidence of anterior translation in Lachman test were higher in the patients who had TT. Lysholm activity level of patients who had TT, 33.3% (n = 9) were excellent, 51.9% (n = 14) were good and 14.8% (n = 4) were moderate; patients who had AT, 57.1% (n = 16) were excellent, 39.3% (n = 11) were good and 3.6% (n = 1) was good level. There was no statistically significant difference between Lysholm Activity level of the patients (p < 0.01). Lysholm Activity level of patients who had AT significantly higher than TT. There was no statistically significant difference between Modified Cincinnati activity level of the patients (p < 0.05). Modified Cincinnati activity level of patients who had AT were significantly higher than those had TT. There was no statistically significant difference between two groups with post treatment IKDC activity level (p < 0.01). Intense activity after treatment rate of patient who had AT was significantly higher than those had TT. There was statistically significant difference between Cybex extension-flexion 60 measurement and extension 240 measurement of the patients (p < 0.01). KT-1000 arthrometer test results with AT was better than the TT in antero-posterior translation of the knee kinematics at 20 and 30 pound of forces. Return to exercise time of patients who had TT was significantly higher than those had AT (p < 0.01). There was no statistically significant difference between return to work time of patients (p > 0.05).
  
  
  CONCLUSIONS
  Single-bundle anatomic ACL reconstruction was better than the TT in term of clinical, functional, and laboratory results. We believe that AT ACL reconstruction will increase in use and traditional method which is TT ACL reconstruction surgery will decrease in the long term. Theoretically, anatomic relocation of the ACL can provide better knee kinematics.
authors.affiliation: Igdir State Hospital Orthopaedics and Traumatology Department, Turkey. Electronic address: dreraykilinc@gmail.com.
authors.forename: Bekir Eray
authors.initials: BE
authors.lastname: Kilinc
authors.affiliation: Istanbul Medipol University Orthopaedics and Traumatology Department, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Kara
authors.affiliation: Sisli Etfal Training and Research Hospital Orthopaedics and Traumatology Department, Turkey.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Oc
authors.affiliation: Zonguldak State Hospital Orthopaedics and Traumatology Department, Turkey.
authors.forename: Haluk
authors.initials: H
authors.lastname: Celik
authors.affiliation: Catalca State Hospital Orthopaedics and Traumatology Department, Turkey.
authors.forename: Savas
authors.initials: S
authors.lastname: Camur
authors.affiliation: İzmir Tepecik Training and Research Hospital, Orthopaedics and Traumatology Department, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Bilgin
authors.affiliation: Erzurum Training and Research Hospital, Sports Medicine, Turkey.
authors.forename: Yunus Turgay
authors.initials: YT
authors.lastname: Erten
authors.affiliation: Istanbul Medical Faculty, Sports Medicine, Turkey.
authors.forename: Turker
authors.initials: T
authors.lastname: Sahinkaya
authors.affiliation: Sisli Etfal Training and Research Hospital Orthopaedics and Traumatology Department, Turkey.
authors.forename: Osman Tugrul
authors.initials: OT
authors.lastname: Eren
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001696:Biomechanical Phenomena; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anatomical single-bundle technique; Anterior cruciate ligament; Transtibial technique