NEW YORK—July 9, 2009
“We found that the anatomy was better reproduced with the anteromedial portal drilling technique compared to the transtibial technique,” said Asheesh Bedi, M.D., a fellow in sports medicine and shoulder surgery at Hospital for Special Surgery who was involved with the study.
In recent years, an improved understanding of the anatomy of the ACL has allowed surgeons to refine techniques to reconstruct the ACL. Investigators at Hospital for Special Surgery (HSS) set out to compare the outcomes of surgeries using two common techniques. “The goal in repairing the ACL is to recreate the normal anatomy, and there are a variety of different techniques to prepare tunnels for ACL reconstruction that have evolved over time,” said Dr. Bedi. “The focus of the study was to compare two very common techniques in terms of their ability to reproduce the native ligament anatomy and restore the stability of the knee after reconstruction in a cadaveric model.”
The investigators used ten matched cadaveric knees to directly compare the transtibial and anteromedial portal drilling technique. The researchers found that the transtibial technique could not reproduce the position of the ACL, whereas the anteromedial portal drilling technique could better restore the native anatomy. The transtibial technique also presented additional concerns. “In preparing the femoral tunnel using the transtibial technique, the tibial tunnel is inadvertently re-reamed as much as 30 percent and can lead to significant time-zero tunnel expansion,” Dr. Bedi said. The transtibial reconstruction also performed inferiorly to the medial portal on a number of biomechanical parameters of stability assessed with computer navigation.
“This study clearly demonstrates that restoring the anatomy of the ACL and the stability of the knee is far superior when the femoral socket is reamed through the anteromedial portal rather than the tibial tunnel, as has been traditionally done by most surgeons,” said David W. Altchek, M.D., attending orthopedic surgeon and co-chief of the Sports Medicine and Shoulder Service at HSS. “HSS is an international leader in this innovative solution toward further improving patient outcomes in ACL surgery.”
According to Dr. Bedi, the work has translated into modified techniques in the operating room at HSS, where more than 800 ACL surgeries are performed each year. Tears of the ACL are quite common, with between 70,000 and 80,000 reported each year in the United States.
Other researchers involved in the study are Volker Musahl, M.D., Volker Steuber, M.D., Daniel Kendoff, M.D., Answorth A. Allen, M.D., and Andrew D. Pearle, M.D., all with the Sports Medicine and Shoulder Service at HSS.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.