Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Orthopaedic Surgery

Purpose: the aim of this study was to compare functional and clinical outcomes of Transtibial, Antromedial Portal and All-inside ACL reconstruction techniques using 4-strand hamstring tendon concerning femoral tunnel position and length, and its affect on the stability. Methods: Prospective Randomized control trial was conducted in kasr Elainy University Hospitals including thirty patients with ACL deficient knees undergoing ACL reconstruction in three groups: Group (1) with transtibial technique using STG, Group (2) with antromedial portal technique using also STG and Group (3) All inside ACL retroconstruction using ST or STG. Patients were followed up two weeks postoperatively, 6 weeks, every 3 months for a year. At every follow up visit a thorough clinical assessment was done along. At 3 months after surgery, a computed tomography (CT) scan of the knee was performed, and tunnel position was analyzed in the coronal and sagittal planes. The International Knee Documentation Committee (IKDC) score of all 3 groups was compared after 1 year. Results: excellent clinical results were achieved in all groups, which showed comparable IKDC scores. No failures were recorded. In the high-to-low direction, the position of the femoral tunnel, as measured using the quadrant method, was lowest in group 2 (Antromedial) with Mean 26.09 ± 7.24 SD and was highest in group 1 (Transtibial) with Mean 4.66 ± 6.93 SD Conclusions: we found that There is a growing evidence that anatomic (Antromedial or All inside) techniques of the femoral tunnel placement in ACL reconstruction confers biomechanical advantages over the traditional Trans-tibial tunnel position.

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