Objective: This retrospective study compares the functional and radiological outcomes of conventional transtibial (cTT), modified transtibial (mTT), and transportal (TP) femoral tunnel drilling techniques in arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction.
Materials and Methods: A total of 229 patients (79 cTT, 79 mTT, and 71 TP) were included, with a mean follow-up of 32.8±7.0 months. Functional outcomes were evaluated using the Lysholm Knee Score (LKS) and Lachman test. Femoral tunnel length and graft diameter were recorded intraoperatively. ACL integrity was assessed via knee magnetic resonance imaging (MRI) at the final follow-up.
Results: The cTT group had significantly lower LKS scores compared to the mTT and TP groups (p=0.0001). Lachman test results showed greater knee stability in the mTT and TP groups compared to the cTT group (p=0.001), with no significant difference between mTT and TP (p=0.823). Femoral tunnel length was longest in the cTT group, followed by the mTT group, and shortest in the TP group (p=0.0001). MRI revealed a lower re-rupture rate in the mTT and TP groups compared to the cTT group (p=0.001), with no difference between mTT and TP (p=0.870).
Conclusion: The mTT technique yields clinical outcomes and re-rupture rates that are superior to the cTT technique and comparable to the TP technique. Additionally, the mTT technique allows for a longer femoral tunnel compared to the TP technique. Therefore, the mTT technique can be used as an alternative to the TP technique.