{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:49:57Z","timestamp":1789055397749,"version":"build-2803163510"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2010,11,1]],"date-time":"2010-11-01T00:00:00Z","timestamp":1288569600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2010,11,1]],"date-time":"2010-11-01T00:00:00Z","timestamp":1288569600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2010,11,1]],"date-time":"2010-11-01T00:00:00Z","timestamp":1288569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2010,11,1]],"date-time":"2010-11-01T00:00:00Z","timestamp":1288569600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100013018","name":"Hospital for Special Surgery","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013018","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2011,3]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The purpose of this study was to objectively evaluate the anatomic and biomechanical outcomes of anterior cruciate ligament (ACL) reconstruction with transtibial versus anteromedial portal drilling of the femoral tunnel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Ten human cadaveric knees (5 matched pairs) without ligament injury or pre\u2010existing arthritis underwent ACL reconstruction by either a transtibial or anteromedial portal technique. A medial arthrotomy was created in all cases before reconstruction to determine the center of the native ACL tibial and femoral footprints. A 10\u2010mm tibial tunnel directed toward the center of the tibial footprint was prepared in an identical fashion, starting at the anterior border of the medial collateral ligament in all cases. For transtibial femoral socket preparation (n = 5), a guidewire was placed as close to the center of the femoral footprint as possible. With anteromedial portal reconstruction (n = 5), the guidewire was positioned centrally in the femoral footprint and the tunnel drilled through the medial portal in hyperflexion. An identical graft was fixed and tensioned, and knee stability was assessed with the following standardized examinations: (1) anterior drawer, (2) Lachman, (3) maximal internal rotation at 30\u00b0, (4) manual pivot shift, and (5) instrumented pivot shift. Distance from the femoral guidewire to the center of the femoral footprint and dimensions of the tibial tunnel intra\u2010articular aperture were measured for all specimens. Statistical analysis was completed with a repeated\u2010measures analysis of variance and Tukey multiple comparisons test with\n                      <jats:italic>P<\/jats:italic>\n                      \u2264 .05 defined as significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The anteromedial portal ACL reconstruction controlled tibial translation significantly more than the transtibial reconstruction with anterior drawer, Lachman, and pivot\u2010shift examinations of knee stability (\n                      <jats:italic>P<\/jats:italic>\n                      \u2264 .05). Anteromedial portal ACL reconstruction restored the Lachman and anterior drawer examinations to those of the intact condition and constrained translation with the manual and instrumented pivot\u2010shift examinations more than the native ACL (\n                      <jats:italic>P<\/jats:italic>\n                      \u2264 .05). Despite optimal guidewire positioning, the transtibial technique resulted in a mean position 1.94 mm anterior and 3.26 mm superior to the center of the femoral footprint. The guidewire was positioned at the center of the femoral footprint through the anteromedial portal in all cases. The tibial tunnel intra\u2010articular aperture was 38% larger in the anteroposterior dimension with the transtibial versus anteromedial portal technique (mean, 14.9 mm\n                      <jats:italic>v<\/jats:italic>\n                      10.8 mm;\n                      <jats:italic>P<\/jats:italic>\n                      \u2264 .05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The anteromedial portal drilling technique allows for accurate positioning of the femoral socket in the center of the native footprint, resulting in secondary improvement in time\u2010zero control of tibial translation with Lachman and pivot\u2010shift testing compared with conventional transtibial ACL reconstruction. This technique respects the native ACL anatomy but cannot restore it with a single\u2010bundle ACL reconstruction. Eccentric, posterolateral positioning of the guidewire in the tibial tunnel with the transtibial technique results in iatrogenic re\u2010reaming of the tibial tunnel and significant intra\u2010articular aperture expansion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Anteromedial portal drilling of the femoral socket may allow for improved restoration of anatomy and stability with ACL reconstruction compared with conventional transtibial drilling techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2010.07.018","type":"journal-article","created":{"date-parts":[[2010,10,30]],"date-time":"2010-10-30T04:47:19Z","timestamp":1288414039000},"page":"380-390","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":252,"title":["Transtibial Versus Anteromedial Portal Reaming in Anterior Cruciate Ligament Reconstruction: An Anatomic and Biomechanical Evaluation of Surgical Technique"],"prefix":"10.1002","volume":"27","author":[{"given":"Asheesh","family":"Bedi","sequence":"first","affiliation":[{"name":"Sports Medicine &amp; Shoulder Service Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Musahl","sequence":"additional","affiliation":[{"name":"Sports Medicine &amp; Shoulder Service Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Steuber","sequence":"additional","affiliation":[{"name":"Computer Assisted Surgery Laboratory Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kendoff","sequence":"additional","affiliation":[{"name":"Computer Assisted Surgery Laboratory Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Choi","sequence":"additional","affiliation":[{"name":"Laboratory of Biomechanics Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Answorth A.","family":"Allen","sequence":"additional","affiliation":[{"name":"Sports Medicine &amp; Shoulder Service Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Pearle","sequence":"additional","affiliation":[{"name":"Sports Medicine &amp; Shoulder Service Hospital for Special Surgery New York New York U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W.","family":"Altchek","sequence":"additional","affiliation":[{"name":"Sports Medicine &amp; Shoulder Service Hospital for Special Surgery New York New York 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Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}