Background:

Although numerous clinical studies have compared transtibial (TT) and anteromedial portal (AMP) drilling of femoral tunnels during anterior cruciate ligament reconstruction (ACLR), there is no high-quality, evidence-based consensus regarding which technique affords the best outcome.

Hypothesis:

There would be no difference between the TT and AMP techniques in terms of knee stability, patient-reported outcomes, incidence of revision, and radiological results.

Study Design:

Meta-analysis; Level of evidence, 2.

Methods:

The PubMed and EMBASE databases were searched from inception to February 1, 2021. Level 1 and 2 clinical trials that compared TT and AM techniques were included. Data were meta-analyzed for the outcome measures of knee stability, patient-reported functional outcomes, incidence of revision, and radiological results. Dichotomous variables were presented as odds ratios (ORs), and continuous variables were presented as mean differences (MDs) and standard mean differences (SMDs).

Results:

The meta-analysis included 18 clinical studies, level of evidence 1 or 2, that involved 53,888 patients. Pooled data showed that the AMP group had a lower side-to-side difference (SMD, 0.22; 95% CI, 0.06 to 0.39; P = .009), a lower incidence of pivot-shift phenomenon (OR, 3.69; 95% CI, 1.26 to 10.79; P = .02), and a higher postoperative Lysholm score (SMD, −0.26; 95% CI, −0.44 to −0.08; P = .005) than the TT group. However, no statistically significant differences were seen in other outcomes, including subjective International Knee Documentation Committee scores (SMD, –0.11; 95% CI, –0.30 to 0.09; P = .30) or grades (OR, 0.93; 95% CI, 0.35 to 2.49; P = .89), postoperative activity level (MD, –0.14; 95% CI, –0.42 to 0.15; P = .35), and incidence of revision ACLR (OR, 1.04; 95% CI, 0.93 to 1.16; P = .45). The TT technique was more likely to create longer (SMD, 1.05; 95% CI, 0.05 to 2.06; P = .04) and more oblique (SMD, 0.81; 95% CI, 0.51 to 1.11; P < .001) femoral tunnels than the AMP technique, and a higher height ratio of the aperture position was detected with the TT technique (SMD, −3.51; 95% CI, −5.54 to −1.49; P < .001).

Conclusion:

The AMP technique for ACLR may be more likely to produce better knee stability and improved clinical outcomes than the TT technique, but no difference was found in the incidence of revision between the 2 groups.

中文翻译：

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原发性单束前交叉韧带重建中股骨隧道钻孔的小腿与前内侧入路技术：临床、翻修和放射学结果的 1 级和 2 级证据的荟萃分析

背景：

尽管许多临床研究比较了前交叉韧带重建 (ACLR) 期间股骨隧道的经胫骨 (TT) 和前内侧入路 (AMP) 钻孔，但关于哪种技术可提供最佳结果，尚无高质量的循证共识。

假设：

TT 和 AMP 技术在膝关节稳定性、患者报告的结果、翻修发生率和放射学结果方面没有差异。

学习规划：

荟萃分析；证据等级，2。

方法：

从开始到 2021 年 2 月 1 日搜索了 PubMed 和 EMBASE 数据库。包括比较 TT 和 AM 技术的 1 级和 2 级临床试验。对膝关节稳定性、患者报告的功能结果、翻修发生率和放射学结果的结果测量数据进行荟萃分析。二分变量表示为比值比 (OR)，连续变量表示为均值差 (MD) 和标准均值差 (SMD)。

结果：

荟萃分析包括 18 项临床研究，证据级别为 1 或 2，涉及 53,888 名患者。汇总数据显示，AMP 组的侧向差异较低（SMD，0.22；95% CI，0.06 至 0.39；P = .009），枢轴偏移现象的发生率较低（OR，3.69；95% CI，1.26 至 10.79；P = .02），术后 Lysholm 评分（SMD，-0.26；95% CI，-0.44 至 -0.08；P = .005）高于 TT 组。然而，其他结果未见统计学显着差异，包括主观国际膝关节文献委员会评分（SMD，–0.11；95% CI，–0.30 至 0.09；P = .30）或等级（OR，0.93；95% CI， 0.35 至 2.49；P= .89）、术后活动水平（MD，–0.14；95% CI，–0.42 至 0.15；P = .35）和 ACLR 翻修发生率（OR，1.04；95% CI，0.93 至 1.16；P = . 45). TT 技术更有可能创建更长（SMD，1.05；95% CI，0.05 至 2.06；P = .04）和更倾斜（SMD，0.81；95% CI，0.51 至 1.11；P < .001）的股骨隧道与 AMP 技术相比，TT 技术检测到更高的孔径位置高度比（SMD，-3.51；95% CI，-5.54 至 -1.49；P < .001）。

结论：

与 TT 技术相比，ACLR 的 AMP 技术可能更有可能产生更好的膝关节稳定性和改善的临床结果，但两组之间的翻修发生率没有差异。