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Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression.

Publication ,  Journal Article
Riboh, JC; Hasselblad, V; Godin, JA; Mather, RC
Published in: Am J Sports Med
November 2013

BACKGROUND: While numerous cadaveric, in vivo, and clinical studies have compared transtibial and independent drilling of femoral tunnels during anterior cruciate ligament reconstruction, there is no evidence-based consensus on which technique affords the best outcome. HYPOTHESIS: There is no difference in clinical outcome between transtibial and independent drilling of femoral tunnels. STUDY DESIGN: Systematic review with meta-analysis and meta-regression. METHODS: Cadaveric, in vivo, and clinical studies comparing transtibial and independent drilling techniques were systematically identified. A qualitative synthesis of nonrandomized studies and meta-analysis of randomized controlled trials (RCTs) were performed. In addition, a meta-regression analysis of RCTs that did not directly compare drilling techniques was performed. RESULTS: A total of 49 studies were included in the qualitative review, and 15 were included in the meta-analysis; 22 studies were included in the meta-regression. In biomechanical studies, independent drilling placed the center of the femoral tunnel closer to the center of the femoral footprint (mean difference, 2.69 mm; 95% CI, 0.46-4.92; P < .00001). Independent drilling reduced anterior tibial translation with the Lachman examination (mean difference, 2.2 mm; 95% CI, 0.34-4.07; P = .02), 134 N of anterior load (mean difference, 1 mm; 95% CI, 0.29-1.71; P = .006), and simulated pivot shift (mean difference, 3.36 mm; 95% CI, 1.88-4.85; P < .00001). The meta-analysis showed improved Lysholm scores with independent drilling (mean difference, -0.62 points; 95% CI, -1.09 to -0.55; P = .009), although the clinical relevance of this small difference is questionable. There were no significant differences in International Knee Documentation Committee (IKDC) objective scores or Tegner scores between groups. With the meta-regression, there were no significant differences in failure rates or IKDC objective scores. CONCLUSION: While there are biomechanical data suggesting improved knee stability and more anatomic graft placement with independent drilling, no significant clinical differences were found between the 2 techniques. CLINICAL RELEVANCE: The current evidence shows that transtibial and independent drilling techniques have equivalent clinical outcomes at short-term to midterm follow-up. The long-term effects of subtle differences in tunnel position and postoperative knee kinematics should be further studied in dedicated, prospective cohort and randomized studies.

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Published In

Am J Sports Med

DOI

EISSN

1552-3365

Publication Date

November 2013

Volume

41

Issue

11

Start / End Page

2693 / 2702

Location

United States

Related Subject Headings

  • Tibia
  • Regression Analysis
  • Orthopedics
  • Knee Joint
  • Humans
  • Femur
  • Biomechanical Phenomena
  • Anterior Cruciate Ligament Reconstruction
  • 4207 Sports science and exercise
  • 4201 Allied health and rehabilitation science
 

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Riboh, J. C., Hasselblad, V., Godin, J. A., & Mather, R. C. (2013). Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression. Am J Sports Med, 41(11), 2693–2702. https://doi.org/10.1177/0363546513506979
Riboh, Jonathan C., Vic Hasselblad, Jonathan A. Godin, and Richard C. Mather. “Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression.Am J Sports Med 41, no. 11 (November 2013): 2693–2702. https://doi.org/10.1177/0363546513506979.
Riboh, Jonathan C., et al. “Transtibial versus independent drilling techniques for anterior cruciate ligament reconstruction: a systematic review, meta-analysis, and meta-regression.Am J Sports Med, vol. 41, no. 11, Nov. 2013, pp. 2693–702. Pubmed, doi:10.1177/0363546513506979.
Journal cover image

Published In

Am J Sports Med

DOI

EISSN

1552-3365

Publication Date

November 2013

Volume

41

Issue

11

Start / End Page

2693 / 2702

Location

United States

Related Subject Headings

  • Tibia
  • Regression Analysis
  • Orthopedics
  • Knee Joint
  • Humans
  • Femur
  • Biomechanical Phenomena
  • Anterior Cruciate Ligament Reconstruction
  • 4207 Sports science and exercise
  • 4201 Allied health and rehabilitation science