A comparison of clinical and radiological parameters with two arthroscopic techniques for anterior cruciate ligament reconstruction

Abstract We performed a comparative study of two series of 25 patellar tendon arthroscopic reconstructions of isolated chronic anterior cruciate ligament injuries, alternating between a double‐incision (using a rear‐entry guide) or single‐incision technique (using a transtibial approach). The patients were reviewed to assess the clinical, KT‐2000 and radiological differences at an average follow‐up of 14 months (range 8–18 months). For the clinical evaluation the International Knee Documentation Committee Form was used. The following radiographic parameters were measured: (1) the direction of the femoral and tibial tunnels in the antero‐posterior (AP) and lateral (LL) views; (2) the location of the anterior border of the intra‐articular exit hole of the femoral tunnel in the LL radiologic view; (3) femoral interference screw divergence with the bone block. An extension loss ≤5° was detected in 40% of the double‐incision and 36% of the single‐incision patients (NS). A flexion loss≤10° was present in 8% of the double‐incision and 16% of single‐incision group (NS). There were no differences in terms of pivot shift test between the two groups (pivot glide in 12% of both groups). The average side‐to‐side KT‐2000 differences at the manual maximum test were 1.98 mm in the double‐incision and 2.64 mm in the single‐incision group. With the double‐incision technique the fermoral and tibial tunnels were divergent in the AP plane and crossed the joint at an angle of 37° and 72°, respectively. With the single‐incision technique the bone tunnels were almost parallel and crossed the joint at an average angle of 68°. The location of the intra‐articular exit of the femoral tunnel was posterior in both techniques (63% and 66%, respectively). Screw divergence (≥20°) on the femoral side was absent in the double‐incision and present in 12% in the single‐incision group (NS). In conclusion, even without straight line tunnels, satisfactory results in terms of stability may be obtained. Despite our similar results, we feel that the single‐incision technique is perhaps preferable because there is less postoperative pain and swelling, and it is preferred by the patients. The single‐incision technique has a long learning curve.