Research on this recommendation did not evaluate the techniques used for ACL reconstructions in skeletally immature patients. The tibial independent approach included both outside-in and medial portal drilling techniques. The studies demonstrate no consistent differences between the two techniques in objective metrics or patient reported outcomes. Meta-analysis of the study demonstrated no difference in IKDC knee exam or Lysholm scores.
Potential Harms of Implementation
As with all surgical techniques, there are potential complications such as malposition of the femoral tunnel or femoral tunnel blowout.
Prospective randomized trials comparing the results of ACL reconstruction with femoral tunnels created using tibial independent and trans-tibial approaches should be performed to evaluate difference in objective metrics including limits of knee motion, and patient reported outcomes.
- (18) Brandsson S, Faxen E, Eriksson BI, Sward L, Lundin O, Karlsson J. Reconstruction of the anterior cruciate ligament: comparison of outside-in and all-inside techniques. Br J Sports Med 1999;33:42-45.
- (44) Harner CD, Marks PH, Fu FH, Irrgang JJ, Silby MB, Mengato R. Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique. Arthroscopy 1994;10:502-512.
- (73) Nakamae A, Ochi M, Adachi N, Deie M, Nakasa T. Clinical comparisons between the transtibial technique and the far anteromedial portal technique for posterolateral femoral tunnel drilling in anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2012;28:658-666.
- (74) Noh JH, Roh YH, Yang BG, Yi SR, Lee SY. Femoral tunnel position on conventional magnetic resonance imaging after anterior cruciate ligament reconstruction in young men: transtibial technique versus anteromedial portal technique. Arthroscopy 2013;29:882-890.
- (78) O'Neill DB. Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques. J Bone Joint Surg Am 1996;78:803-813.
- (81) Otsuka H, Ishibashi Y, Tsuda E, Sasaki K, Toh S. Comparison of three techniques of anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Differences in anterior tibial translation and tunnel enlargement with each technique. Am J Sports Med 2003;31:282-288.
- (82) Panni AS, Milano G, Tartarone M, Demontis A, Fabbriciani C. Clinical and radiographic results of ACL reconstruction: a 5- to 7-year follow-up study of outside-in versus inside-out reconstruction techniques. Knee Surg Sports Traumatol Arthrosc 2001;9:77-85.
- (9) Alentorn-Geli E, Samitier G, Alvarez P, Steinbacher G, Cugat R. Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up. Int Orthop 2010;34:747-754.
- (98) Santori N, Condello V, Maresca G, Adriani E, Mariani PP. Clinical and radiologic comparison of one- and two-incision technique for arthroscopic ACL reconstruction with patellar tendon. Orthopaedics International Edition 1996;4:411-418.