Koray BAŞDELİOĞLU, GÖKHAN MERİÇ, Zekine PÜNDÜK, Devrim AKSEKİ, AZİZ ATİK, SERDAR SARGIN

Outcomes of isokinetic tests and functional assessment of anterior cruciate ligament reconstruction: Transtibial versus single anatomic femoral tunnel technique

Objective: The aim of the study was to compare the outcomes of the transtibial and anatomical femoralsingle tunnel surgical techniques in ACL reconstruction.Methods: A total of 30 patients, with 16 patients (15 males and 1 female; mean age: 27.2 ± 7.04) withanatomical femoral single-tunnel technique (AFT) and 14 (12 males and 2 females; mean age:29.4 ± 8.82) with transtibial technique (TT) were included into the study. All patients were evaluatedwith isokinetic tests at an angular velocity of 60/s and 180/s and the IKDC and Lysholm tests wereperformed preoperatively and in third, sixth, and 12th months postoperatively. The results werecompared between the groups. The mean follow-up time was 17.1 ± 6.48 months.Results: Postoperative third month changes in extension parameters of peak torque (AFT: 93.286,TT: 61.500), peak work (AFT: 77.071, TT: 47.500), peak torque ext/kg (AFT: 1.182, TT: 0.773), peakwork ext/kg (AFT: 0.982, TT: 0.604), peak work (AFT: 55.143 TT: 33.063) at an angular velocity of60/s and postoperative third month change in extension parameter of peak power (AFT: 86.786TT: 54.875) at an angular velocity of 180/s were found to be better in the transtibial group (p < 0.05)and postoperative sixth month peak torque (AFT: 1.429, TT: 5.688) value at an angular velocity of 60/s was found to be less in the anatomical femoral single-tunnel group (p < 0.05). The IKDC (AFT: 94.671,TT: 90.025) (p < 0.05) and Lysholm (AFT: 96.714, TT: 92.375) (p < 0.05) scores of the anatomical femoralsingle-tunnel group were better than the transtibial group regarding to the postoperative final follow-up.There are positive intermediate correlations between preoperative IKDC and Lysholm scores with preoperative and postoperative some isokinetic test ratio (r ¼ 0.539; p ¼ 0.031), and preoperative peakpower extension (r ¼ 0.541; p ¼ 0.030) at the both angular velocity of 60/s and 180/s in the transtibialgroup. There was no significant difference between the two groups with regards to the Lachman, anteriordrawer and pivot shift tests (p < 0.05).Conclusion: There were differences in terms of isokinetic parameters in early outcomes but there was nostatistical difference between isokinetic parameters at the end of 1st year between two groups. Therewere some correlations between IKDC and Lysholm scores with some isokinetic parameters.

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Markatos K, Kaseta MK, Lallos SN, Korres DS, Efstathopoulos N. The anatomy of the ACL and its importance in ACL reconstruction. Eur J Orthop Surg Traumatol. 2013;23(7):747e752.

Callaghan MJ. Conservative treatment of complete ACL tears. J Bone Joint Surg Br. 1996;78(4):680e681. Epub 1996/07/01.

Zysk SP, Refior HJ. Operative or conservative treatment of the acutely torn anterior cruciate ligament in middle-aged patients. A follow-up study of 133 patients between the ages of 40 and 59 years. Arch Orthop Trauma Surg. 2000;120(1e2):59e64. Epub 2000/02/01.

Kim SJ, Park KH, Kim SH, Kim SG, Chun YM. Anterior cruciate ligament reconstruction improves activity-induced pain in comparison with pain at rest in middle-aged patients with significant cartilage degeneration. Am J Sports Med. 2010;38(7):1343e1348. Epub 2010/06/05.

Koutras G, Papadopoulos P, Terzidis IP, Gigis I, Pappas E. Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1904e1909. Epub 2012/12/04.

Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH. Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy. 2011;27(5):653e665. Epub 2011/06/15.

de Jong SN, van Caspel DR, van Haeff MJ, Saris DB. Functional assessment and muscle strength before and after reconstruction of chronic anterior cruciate ligament lesions. Arthroscopy. 2007;23(1):21e28, 8 e1e3. Epub 2007/01/11.

Zeng C, Gao SG, Li H, et al. Autograft versus allograft in anterior cruciate ligament reconstruction: a meta-analysis of randomized controlled trials and systematic review of overlapping systematic reviews. Arthroscopy. 2016;32(1): 153e163.

Youm YS, Cho SD, Lee SH, Youn CH. Modified transtibial versus anteromedial portal technique in anatomic single-bundle anterior cruciate ligament reconstruction: comparison of femoral tunnel position and clinical results. Am J Sports Med. 2014;42(12):2941e2947. Epub 2014/10/02.

Tiefenboeck TM, Thurmaier E, Tiefenboeck MM, et al. Clinical and functional outcome after anterior cruciate ligament reconstruction using the LARS system at a minimum follow-up of 10 years. Knee. 2015;22(6):565e568.

Desai N, Alentorn-Geli E, van Eck CF, et al. A systematic review of single- versus double-bundle ACL reconstruction using the anatomic anterior cruciate ligament reconstruction scoring checklist. Knee Surg Sports Traumatol Arthrosc. 2016;24(3):862e872.

Komzak M, Hart R, Smid P, Puskeiler M. [The effect of central anatomical single-bundle versus anatomical double-bundle reconstruction of the anterior cruciate ligament on knee stability. a clinical study]. Acta Chir Orthop Traumatol Cech. 2014;81(4):276e280. Epub 2014/08/20.

Miller MD. Dele & Drez's 2010 Orthopaedic Sports Medicine. Saunders, an imprint of Elsevier Inc; 2010.

Bizzini M, Gorelick M, Munzinger U, Drobny T. Joint laxity and isokinetic thigh muscle strength characteristics after anterior cruciate ligament reconstruction: bone patellar tendon bone versus quadrupled hamstring autografts. Clin J Sport Med. 2006;16(1):4e9. Epub 2005/12/27.

Adams GM. Exercise Physiology Isokinetic Strength. 1998.

Lee DH, Lee JH, Jeong HJ, Lee SJ. Serial changes in knee muscle strength after anterior cruciate ligament reconstruction using hamstring tendon autografts. Arthroscopy. 2015;31(5):890e895. Epub 2015/03/17.

Dvir Z. _ Isokinetics, Muscle Testing, Interpretations and Clinical Application. 2nd ed. 2004:137e167.

Weir JP, Housh TJ, Johnson GO, Housh DJ, Ebersole KT. Allometric scaling of isokinetic peak torque: the Nebraska Wrestling Study. Eur J Appl Physiol Occup Physiol. 1999;80(3):240e248. Epub 1999/08/24.

Pastrone A, Ferro A, Bruzzone M, et al. Anterior cruciate ligament reconstruction creating the femoral tunnel through the anteromedial portal. Surgical technique. Curr Rev Musculoskelet Med. 2011;4(2):52e56. Epub 2011/05/05.

Harner CD, Honkamp NJ, Ranawat AS. Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy. 2008;24(1):113e115. Epub 2008/01/12.

Lubowitz JH. Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy. 2009;25(1):95e101. Epub 2008/12/30.

Rue JP, Ghodadra N, Lewis PB, Bach Jr BR. Femoral and tibial tunnel position using a transtibial drilled anterior cruciate ligament reconstruction technique. J Knee Surg. 2008;21(3):246e249. Epub 2008/08/09.

Lee MC, Seong SC, Lee S, et al. Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy. 2007;23(7):771e778. Epub 2007/07/20.

Sinha S, Naik AK, Arya CS, Arya RK, Jain VK, Upadhyay G. Trans-tibial guide wire placement for femoral tunnel in single bundle anterior cruciate ligament reconstruction. Indian J Orthop. 2015;49(3):352e356. Epub 2015/05/28.

Scopp JM, Jasper LE, Belkoff SM, Moorman CT. The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy. 2004;20(3):294e299.

Yosmaoglu HB, Baltaci G, Kaya D, Ozer H, Atay A. Comparison of functional outcomes of two anterior cruciate ligament reconstruction methods with hamstring tendon graft. Acta Orthop Traumatol Turc. 2011;45(4):240e247. Epub 2011/09/13.

Aydin D, Ozcan M. Evaluation and comparison of clinical results of femoral fixation devices in arthroscopic anterior cruciate ligament reconstruction. Knee. 2016;23(2):227e232.