Orthopedic Department, Faculty of Medicine, Ain Shams University, Al-Abbasya District, Cairo, Egypt.
El Demerdash Hospital, Ain-Shams University, Cairo, Egypt.
J Orthop Surg Res. 2022 Mar 18;17(1):166. doi: 10.1186/s13018-022-03040-5.
Femoral tunnel can be drilled through tibial tunnel (TT), or independent of it (TI) by out-in (OI) technique or by anteromedial (AM) technique. No consensus has been reached on which technique achieves more proper femoral aperture position because there have been evolving concepts in the ideal place for femoral aperture placement. This meta-analysis was performed to analyze the current literature comparing femoral aperture placement by TI versus TT techniques in ACL reconstruction.
We performed a comprehensive systematic review and meta-analysis of English-language literature in PubMed, Cochrane, and Web of Science databases for articles comparing femoral aperture placement by TI versus TT techniques with aperture position assessed by direct measurement or by postoperative imaging, PXR and/or CT and/or MRI.
We included 55 articles with study population of 2401 knees of whom 1252 underwent TI and 1149 underwent TT techniques. The relevant baseline characteristics, whenever compared, were comparable between both groups. There was nonsignificant difference between TI and TT techniques in the distance from aperture center to footprint center and both techniques were unable to accurately recreate the anatomic footprint position. TI technique significantly placed aperture at more posterior position than TT technique. TI technique significantly lowered position of placed aperture perpendicular to Blumensaat's line (BL) than TT technique, and modifications to TT technique had significant effect on this intervention effect. Regarding sagittal plane aperture placement along both AP anatomical axis and BL, there was nonsignificant difference between both techniques.
Modifications to TT technique could overcome limitations in aperture placement perpendicular to BL. The more anterior placement of femoral aperture by TT technique might be considered, to some extent, a proper position according to recent concept of functional anatomical ACL reconstruction.
股骨隧道可以通过胫骨隧道（TT）或通过外入内（OI）技术或前内侧（AM）技术独立于 TT 进行钻孔。由于股骨开口位置的理想位置存在不断发展的概念，因此哪种技术能达到更合适的股骨开口位置尚未达成共识。本荟萃分析旨在分析比较 ACL 重建中 TT 与 TI 技术股骨开口位置的当前文献。
我们在 PubMed、Cochrane 和 Web of Science 数据库中进行了全面的系统综述和荟萃分析，以比较 TI 与 TT 技术的股骨开口位置评估，通过直接测量或术后影像学、PXR 和/或 CT 和/或 MRI 评估。
我们纳入了 55 篇文章，研究人群为 2401 膝，其中 1252 膝采用 TI 技术，1149 膝采用 TT 技术。两组的相关基线特征比较时具有可比性。在开口中心到足迹中心的距离方面，TI 与 TT 技术之间无显著性差异，两种技术均无法准确重建解剖学足迹位置。TI 技术明显将开口置于更靠后的位置，而 TT 技术则相反。TI 技术明显降低了垂直于 Blumensaat 线（BL）放置的开口位置，而 TT 技术的修改对这种干预效果有显著影响。关于矢状面开口沿 AP 解剖轴和 BL 的放置，两种技术之间无显著性差异。
TT 技术的修改可以克服垂直于 BL 放置开口的局限性。TT 技术的股骨开口更靠前的放置，在某种程度上可以被认为是根据最近的功能性解剖 ACL 重建概念的适当位置。
