Transtibial versus Independent Femoral Tunnel Drilling Techniques for Arthroscopic Anterior Cruciate Ligament Reconstruction Evaluation of Femoral Aperture Positioning Systematic review and Meta-analysis

Abstract

Preparation of the femoral tunnel plays an important role in knee stability following arthroscopic ACLR. The most common method for preparing the femoral tunnel was the (TT) drilling technique according to a 2009 survey (134). However, in the most recent surveys, published in 2013 and 2015, they found that 68% of surgeons are using an independent drilling technique,(AM) technique, and only 31% are still using a TT guide (135). We have performed the electronic search for PubMed, Cochrane library, Google Scholar, resulting in 2434 studies filtered for title and abstract resulting in 73 studies eligible for full text search, then second filter was done for full text excluding 27 unrelated studies 46 studies were obtained, then by manual search we found 2 studies eligible for research, finally obtaining 48studies 14 cadaveric and 34 clinical studies a eligible for reaching, including 2384 knee. In clinical studies; regarding gender, in 25 studies there were 73 % male and 27 % female. According to side, in 12 studies there were 55 % right and 45 % left knees. According to age, the average age in 29 studies was 28.5 years. Regarding basic science studies; 11 studies didn't report the gender, the remaining 3 studies reported 60 % male and 35 % female, and 5 % unknown gender, 5 studies didn't report the side, while in the remaining 9 studies, there was 54 % right and 48% left knees. 5 studies didn't report the age, the weighted average age in the remaining 11 studies was 67.5 years; which was much more than the average age of clinical studies. Regarding the integrity of intervention there was 60 % of studies performed by single surgeon, while 29 % of studies were performed by 2-4 surgeons, while 11 % of studies were performed by 8-22 surgeons. Regarding TT technique; the extra-articular starting point wasn't reported in 9 studies, it was at the conventional site in 9 studies, more medialized in 21 studies, proximally placed in 3 studies, un classified in 4 studies. The average angle of tibial guide was 55 ̊, the tibial intra articular tibial tunnel point was at the center of footprint in 57.5 % of studies, at AM portion of footprint in 27.5 % of studies and at PL portion of footprint in 15 % of studies. Knee angle during drilling was at average of 90 ̊. Femoral tunnel localization strategy was using freehand in 20 % of studies, and using offset guide at 80 % of studies. There were modifications of TT technique in 9 studies. Tibial tunnel diameter was 8mm in 38 % of studies, 9 mm in 8 % of studies, 9-10 mm in 4 % of studies, 10 mm in 42 % of studies and 10-11 mm in 8 % of studies. Notchplasty was performed in both groups in 7 studies and in TT group only in 5 studies.