Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jan;27(1):124-129.
doi: 10.1007/s00167-018-5036-x. Epub 2018 Jul 12.

Transportal central femoral tunnel placement has a significantly higher revision rate than transtibial AM femoral tunnel placement in hamstring ACL reconstruction

Mark Clatworthy  1 , Steffen Sauer  2 , Tim Roberts  3
Affiliations

Transportal central femoral tunnel placement has a significantly higher revision rate than transtibial AM femoral tunnel placement in hamstring ACL reconstruction

Mark Clatworthy et al. Knee Surg Sports Traumatol Arthrosc. 2019 Jan.

Abstract

Purpose: It is proposed that central femoral ACL graft placement better controls rotational stability. This study evaluates the consequence of changing the femoral tunnel position from the AM position drilled transtibially to the central position drilled transportally. The difference in ACL graft failure is reported.

Methods: This prospective consecutive patient single surgeon study compares the revision rates of 1016 transtibial hamstring ACL reconstructions followed for 6-15 years with 464 transportal hamstring ACL reconstructions followed for 2-6 years. Sex, age, graft size, time to surgery, meniscal repair and meniscectomy data were evaluated as contributing factors for ACL graft failure to enable a multivariate analysis. To adjust for the variable follow-up a multivariate hazard ratio, failure per 100 graft years and Kaplan-Meier survivorship was determined.

Results: With transtibial ACLR 52/1016 failed (5.1%). With transportal ACLR 32/464 failed (6.9%). Significant differences between transportal and transtibial ACLR were seen for graft diameter, time to surgery, medial meniscal repair rates and meniscal tissue remaining after meniscectomy. Adjusting for these the multivariate hazard ratio was 2.3 times higher in the transportal group (p = 0.001). Central tunnel placement resulted in a significantly 3.5 times higher revision rate compared to an anteromedial tunnel placement per 100 graft years (p = 0.001). Five year survival was 980/1016 (96.5%) for transtibial versus 119/131 (90.5%) for transportal. Transportal ACLR also showed a significantly higher earlier failure rate with 20/32 (61%) of the transportal failing in the first year compared with 14/52 (27%) for transtibial. (p = 0.001.) CONCLUSION: Transportal central femoral tunnel ACLR has a higher failure rate and earlier failure than transtibial AM femoral tunnel ACLR.

Level of evidence: Level II-prospective comparative study.

Keywords: ACL failure; ACL reconstruction; ACL surgical technique.

PubMed Disclaimer

References

    1. Arthroscopy. 2003 Mar;19(3):297-304 - PubMed
    1. Knee Surg Sports Traumatol Arthrosc. 2014 Feb;22(2):336-44 - PubMed
    1. Knee Surg Sports Traumatol Arthrosc. 2015 Nov;23(11):3143-50 - PubMed
    1. J Biomech. 2014 Jan 3;47(1):96-101 - PubMed
    1. Arthroscopy. 2015 Mar;31(3):435-44 - PubMed