Central Transpatellar Tendon Portal Is Safe When Used for Anterior Cruciate Ligament Reconstruction

Abstract

Central transpatellar tendon portal (CTP) was suggested first for complex meniscal lesion and subsequently for a better femoral footprint view during reconstruction of anterior cruciate ligament (ACL). A comprehensive evaluation of possible consequences of using the CTP performing an ACL reconstruction does not exist. Our hypothesis was that the use of CTP for ACL reconstruction does not lead to a higher rate of complications or clinically evident radiological abnormalities. In total, 141 patients were prospectively evaluated, 69 underwent ACL reconstruction using a standard high medial portal as view portal, and 72 where a CTP was used. Clinical evaluation, Kujala's score, patellar height, and magnetic resonance (MR) abnormalities were evaluated up to 1-year follow-up. Clinical complications were reported in 16 cases with no statistically significant differences between the two groups. The group 2 had significantly more MR abnormalities (p = 0.048), but the differences in MR alterations do not have any clinical repercussion even in a sports-active population. No differences were found between the groups in Kujala's score, time to return to work, and sport or patellar height. The overall mean preoperative Caton-Deschamps Index decreased significantly (p = 0.034) postoperatively. Postoperative patellar height seems to slightly decrease after ACL reconstruction regardless of the kind of the portals used intraoperatively and the initial patellar height. Nevertheless, this change in patellar height does not influence the postoperative outcome. CTP used for ACL reconstruction does not lead to significative major clinical complications.

Keywords

ACL reconstruction - three portal technique - central transpatellar tendon portal - patellar tendinitis - Gillquist portal

Publication History

Received: 12 November 2019

Accepted: 21 July 2020

Article published online:
08 September 2020

• References

• 1 Gillquist J, Hagberg G. A new modification of the technique of arthroscopy of the knee joint. Acta Chir Scand 1976; 142 (02) 123-130
• 2 Mulhollan JS. Swedish arthroscopic system. Orthop Clin North Am 1982; 13 (02) 349-362
• 3 Eriksson E, Sebik A. A comparison between the transpatellar tendon and the lateral approach to the knee joint during arthroscopy. A cadaver study. Am J Sports Med 1980; 8 (02) 103-105
• 4 Martino F, Ettorre GC, Macarini L. et al. Tendinopatia del legamento rotuleo secondaria a artroscopia del ginocchio per via transtendinea. Valutazione ecografica. Radiol Med (Torino) 1993; 86 (05) 595-598
• 5 Uzümcügil O, Doğan A, Yalçinkaya M, Mumcuoğlu E, Kabukçuoğlu Y. The three portal (including transpatellar tendon portal) versus two portal technique in the arthroscopic menisectomy procedure for isolated medial bucket-handle type meniscal tears. Eklem Hastalik Cerrahisi 2010; 21 (01) 38-43
• 6 Bayar A, Turhan E, Özer T, Keser S, Ege A, Erdem Z. The fate of patellar tendon and infrapatellar fat pad after arthroscopy via central portal. Knee Surg Sports Traumatol Arthrosc 2008; 16 (12) 1114-1120
• 7 Sommer C, Friederich NF, Müller W. Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 2000; 8 (04) 207-213
• 8 Morgan JA, Dahm D, Levy B, Stuart MJ. MARS Study Group. Femoral tunnel malposition in ACL revision reconstruction. J Knee Surg 2012; 25 (05) 361-368
• 9 Moloney G, Araujo P, Rabuck S. et al. Use of a fluoroscopic overlay to assist arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med 2013; 41 (08) 1794-1800
• 10 Cohen SB, Fu FH. Three-portal technique for anterior cruciate ligament reconstruction: use of a central medial portal. Arthroscopy 2007; 23 (03) 325.e1-325.e5
• 11 Hale CA, Fleiss JL. Interval estimation under two study designs for kappa with binary classifications. Biometrics 1993; 49 (02) 523-534
• 12 Enderlein D, Nielsen T, Christiansen SE, Faunø P, Lind M. Clinical outcome after reconstruction of the medial patellofemoral ligament in patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2458-2464
• 13 Stetson WB, Templin K. Two-versus three-portal technique for routine knee arthroscopy. Am J Sports Med 2002; 30 (01) 108-111
• 14 Mariani PP, Ferretti A, Gigli C, Puddu G. Isokinetic evaluation of the knee after arthroscopic meniscectomy: comparison between anterolateral and central approaches. Arthroscopy 1987; 3 (02) 123-126
• 15 Checa A. Is the central portal a safe approach for arthroscopy of the knee?. Knee Surg Sports Traumatol Arthrosc 2009; 17 (05) 555-556 , author reply 557
• 16 Cook JL, Khan KM, Kiss ZS, Coleman BD, Griffiths L. Asymptomatic hypoechoic regions on patellar tendon ultrasound: a 4-year clinical and ultrasound followup of 46 tendons. Scand J Med Sci Sports 2001; 11 (06) 321-327
• 17 Wang CJ, Huang TW, Jih S. Radiographic assessment of the knee after patellar tendon reconstruction for chronic anterior cruciate ligament deficiency. Chang Gung Med J 2004; 27 (02) 85-90
• 18 Adriani E, Mariani PP, Maresca G, Santori N. Healing of the patellar tendon after harvesting of its mid-third for anterior cruciate ligament reconstruction and evolution of the unclosed donor site defect. Knee Surg Sports Traumatol Arthrosc 1995; 3 (03) 138-143