Poster 305: Hybrid Transtibial Technique for Femoral Tunnel Drilling in Anterior Cruciate Ligament Reconstruction: A Retrospective, Matched Comparison Study to Anteromedial Portal and Transtibial Approaches

Objectives: Improved biomechanical and clinical outcomes have been reported when femoral anterior cruciate ligament (ACL) tunnels are centered on the native footprint. The anteromedial portal (AMP) technique achieves improved aperture position compared to a transtibial (TT) approach but sacrifices technical ease creates shorter more angulated tunnel. A hybrid (HTT) using medial guidance of flexible guide wire may combine strengths both AM TT approaches while mitigating challenges techniques. purpose our study was evaluate efficacy ACLR HTT for tunnel drilling in comparison matched cohorts AMP terms failure/revision requirements patient-reported outcomes. Methods: database consisting all patients with isolated ACL tear primary reconstruction at single center between 2005 2020 retrospectively reviewed. Inclusion criteria were age ³ 13 years time index (ACLR), with/without concomitant meniscal/chondral pathology had minimum 2 year postoperative follow-up. Patients open physes, prior surgical intervention ipsilateral knee, chondral treated high tibial osteotomy/distal osteotomy, other concurrent ligamentous excluded. AMP, TT, meeting inclusion based ± 3 years, same sex, body mass (BMI) Kg/m . Demographical data (Table 1), data, plain radiographic angle measurements anteroposterior lateral films, complications reoperation/revision rates, patient outcome (PRO) scores collected each three cohorts. Results: total 495 included; 170 underwent approach, 162 163 approach. most common graft choice bone patellar tendon (BPTB) (162/170 [95.3%]) (131/162 [80.9%] (158/163 [96.9%]) hamstring 2). median (IQR) sagittal plane showed significant differences 40° (34°, 46°) 32° (27°, 38°) ( P- value < 0.0001) 3). On coronal angles 47° (42°, 52°) 44° (33°, 54°) 55° (47°, 60°) value: 0.001 <0.001 respectively. Recurrent injury knee experienced 3/170 (1.8%) patients, 6/162 (3.7%) 6/163 2-year follow-up 4). When surveyed via phone or email questionnaires, 6/170 (7.4%) HTT, 11/163 (20%), 18/162 (24.3%) responded having further procedures. Knee Osteoarthritis Outcome Score (KOOS) pain score Western Ontario McMaster Universities Arthritis Index (WOMAC) function found be statistically patients. All PRO comparable Conclusions: that lower rates better medium-term [Table: see text][Table: text]