Assessment of Femoral Tunnel Length and Position in ACL Reconstruction Techniques and its Effect on Stability

Abstract Background: The Transtibial (TT), anteromedial portal (AMP), and all-inside (AI) techniques are frequently used in anterior cruciate ligament reconstruction (ACLR). However, there is an ongoing debate over which procedure is superior. Aim of Study: This study Aimed to compare the functional and radiological outcomes following ACLR using these techniques. Patients and Methods: Thirty active adult patients with symptomatic anterior cruciate ligament (ACL) injury were randomly assigned into three equal groups. The first group was treated using the TT technique. The Second and third groupswere managed using theAMP and the AI techniques respectively. All groups had the same postoperative course and were followed for 1 year after surgery. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) subjective knee evaluation score. Radio-logical assessment of the femoral tunnel length and position was documented. Results were evaluated and compared be-tween all groups. Results: This study showed statistically significant post-operative improvement in the subjective IKDC score in all groups, however there was no statistically significant differ-ences between all groups. The TT group showed the largest Femoral graft angle (FGA) with a mean of 62.96±7.71 SD, while the AI group had the smallest FGA with a mean of 40.43±5.97 SD, and this was statistically significant (p-value <0.001). The largest graft inclination angle (GFA) was found in the AI group with a mean of 30.81±9.67 SD, while the TT group had the smallest GFA was in the TT group with a mean of 12.46±4.61 SD, and this was statistically significant (p-value <0.001). The AM group had the most posterior femoral tunnel position with a mean of 33.42±7.01 SD, while the most anterior femoral tunnels were found in the TT group with a mean of 36.03±8.14 SD, showing no statistically significant differences. The AMP group had the most distal FT position with a mean of 26.09±7.24 SD, while the most proximal FT were found in the TT group with a mean of 4.66±6.93 SD, showing statistically significant differences (p-value <0.001). The shortest femoral tunnel was found in the AI group with a mean of 32.24±3.67 SD, while the longest femoral tunnel was present in the TT group with a mean of 41.98±2.94 SD, showing statistically significant differences (p-value <0.001). Conclusion: The AMP technique is a reliable method in ACLR with good functional outcomes, and better radiological results than the TT and the AI techniques regarding the femoral tunnel length and position. The AI technique is a good alter-native ACLR method with more bone preservation and com-parable outcomes to conventional ACLR surgeries.