Comparison of femoral tunnel geometry, using in vivo 3-dimensional computed tomography, during transportal and outside-in single-bundle anterior cruciate ligament reconstruction techniques

Joon Soo Park, Jung-Ho Park, Joon Ho Wang, Chi Heon Oh, Myung Hoi Hwang, Sang Hee Lee, Jae Gyoon Kim

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22 Citations (Scopus)


Purpose To compare the transportal (TP) and outside-in (OI) techniques regarding femoral tunnel position and geometry after anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. Methods This study included 51 patients who underwent anatomic SB ACL reconstruction with the TP (n = 21) or OI (n = 30) technique. All patients underwent 3-dimensional computed tomography 3 days after the operation. The femoral tunnel position (quadrant method), femoral graft bending angle, femoral tunnel length, and posterior wall breakage were assessed by immediate postoperative 3-dimensional computed tomography with OsiriX imaging software. Results The OI technique had a shallower femoral tunnel position (arthroscopic position) than did the TP technique (P =.005). The mean femoral graft bending angle was significantly more acute with the OI technique (101.3° ± 8.2°) than with the TP technique (107.9° ± 10.0°) (P =.02). The mean femoral tunnel length was significantly greater with the OI technique (33.0 ± 3.5 mm) than with the TP technique (29.6 ± 3.9 mm) (P =.003). Posterior wall breakage occurred in 7 cases (33.3%) with the TP technique and 1 case (3.3%) with the OI technique (P =.02). Conclusions The mean femoral tunnel position was significantly shallower (arthroscopic position) with the OI technique than with the TP technique. The OI technique resulted in a more acute femoral graft bending angle, longer femoral tunnel length, and lower incidence of posterior wall breakage than did the TP technique. These results might be helpful for anatomic SB ACL reconstruction using TP and OI techniques. Level of Evidence Level III, retrospective comparative study.

Original languageEnglish
Pages (from-to)83-91
Number of pages9
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Issue number1
Publication statusPublished - 2015 Jan 1


ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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