Hybrid transtibial ACL reconstruction approach may combine benefits of other techniques
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Radiographic outcomes showed hybrid transtibial ACL reconstruction conferred tunnel characteristics and femoral aperture position similar to that attained with transtibial and anteromedial portal techniques, a presenter said.
David P. Trofa, MD, of OrthoCarolina, presented the findings at the American Orthopaedic Society for Sports Medicine Annual Meeting, which was held virtually. The researchers received the AOSSM 2020 Excellence in Research Award, which is given to the best paper in any category with a primary author younger than 40 years at the time of the meeting.
Trofa and colleagues conducted a prospective, randomized controlled trial to compare tunnel characteristics when primary ACL surgery was performed with a transtibial, anteromedial (AM) or hybrid transtibial technique, the latter of which had more than 90% aperture overlap of the native ACL in earlier cadaveric testing.
By comparison, aperture overlap was 37% and about 80% for the transtibial and AM approaches, respectively, in the same cadaveric testing, according to Trofa.
For this in vivo study, Trofa said, “Our hypothesis was that the hybrid transtibial would create femoral aperture positions as anatomic as the AM approach while maintaining the desirable tunnel characteristics of the transtibial approach.”
The 10 patients in each of the three groups studied had similar demographics, including concomitant injuries.
Researchers studied patients’ 3D-CT scans obtained at 6 weeks postoperatively to assess femoral tunnel angulation in the sagittal and coronal plane, tunnel length and aperture position measured using the quadrant technique. Despite no differences in tibial aperture position or tunnel lengths, the results showed “the three groups had significant differences in femoral tunnel length, aperture position and angulation,” Trofa said. “When individual groups were compared, it was found that the anteromedial portal technique resulted in tunnels which were significantly shorter and more angulated than the hybrid and transtibial approach with no difference in femoral aperture positioning.”
When all results were taken into consideration, the researchers’ hypothesis was correct, Trofa noted.
“The hybrid approach may represent a beneficial combination of both the transtibial and anteromedial techniques,” he said.
As this investigation only included radiographic outcomes, which researchers noted was a main limitation of the study, the researchers are involved in a larger, multicenter study that is underway to assess patient-reported outcomes, according to Trofa.
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Trofa DP, et al. Podium presentation 27. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 8-9, 2020 (virtual meeting).
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