KNEE Short-term functional and clinical outcomes after ACL reconstruction with hamstrings autograft: transtibial versus anteromedial portal technique Georgios Koutras • Pericles Papadopoulos • Ioannis P. Terzidis • Ioannis Gigis • Evangelos Pappas Received: 3 August 2012 / Accepted: 19 November 2012 / Published online: 1 December 2012 Ó Springer-Verlag Berlin Heidelberg 2012 Abstract Purpose Several studies have suggested that drilling the femoral tunnel through an anteromedial arthroscopic portal during anterior cruciate ligament reconstruction allows more anatomic placement of the graft. However, no studies have investigated whether the anteromedial approach results in better outcomes compared to the traditional transtibial drilling approach when a hamstring autograft is used. The purpose of the present study is to investigate short-term functional and clinical outcome differences between male patients recovering from anterior cruciate ligament reconstruction with a hamstring autograft using the transtibial femoral tunnel drilling approach versus the anteromedial approach. Methods Lysholm score, functional test and isokinetic data were collected at 3 and 6 months after surgery in 51 male patients who received a standardized rehabilitation in a large outpatient facility. Multivariate and univariate analyses of variance were used to assess group, time and interaction effects. Results All outcomes except isokinetic knee flexion at 180°/s improved from 3 to 6 months for both groups (p B 0.05). The anteromedial approach group had better Lysholm scores at 3 months (p B 0.05) and better perfor- mance in the timed lateral movement functional tests at 3 and 6 months (p B 0.05). No other comparisons were significant (n.s). Conclusions Both groups had comparable outcomes on most measures. The differences in the Lysholm score and lateral movement functional tests may suggest a quicker return of function and performance for the anteromedial approach group. Clinicians should take into consideration the surgical technique as they progress patients recovering from ACL reconstruction through the different phases of the rehabilitation protocol. Level of evidence Therapeutic study, Level II. Keywords Femoral tunnel drilling Á Anatomic ACL reconstruction Á Rotational instability Á Rehabilitation outcomes Introduction Anterior cruciate ligament (ACL) tear is a serious injury that results in immediate knee instability, loss of the entire athletic season, lengthy rehabilitation and increased risk for early- onset knee osteoarthritis [18]. The optimal surgical technique for ACL reconstruction remains a topic of controversy. The transtibial (TT) technique where the femoral tunnel is drilled through the tibial tunnel is the most traditional and popular G. Koutras Department of Physical Therapy, Technological Education Institute of Thessaloniki, Thessaloniki, Greece P. Papadopoulos Department of Orthopaedics, General Hospital Papanikolaou, Aristotle University of Thessaloniki, Thessaloniki, Greece I. P. Terzidis St. Loukas General Hospital, Thessaloniki, Greece I. Gigis 2nd Orthopaedic Department, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece E. Pappas (&) Department of Physical Therapy, Long Island University-Brooklyn Campus, 1 University Plaza, HS 219, Brooklyn, NY 11201, USA e-mail: evangelos.pappas@liu.edu 123 Knee Surg Sports Traumatol Arthrosc (2013) 21:1904–1909 DOI 10.1007/s00167-012-2323-9