Home Publications Research Data Research Grants Equipment Inventions & Patents Awards Additional Research Activities Faculties & Institutions Research Areas

Anteromedial drilling improves rotational stability but not clinical outcomes in anterior cruciate ligament reconstruction: an umbrella review of level I meta-analyses

Migliorini F, Schäfer L, Pilone M, Giai Via R, Betsch M, Boosz P (2026)

---

Publication Type: Journal article, Review article

Publication year: 2026

Journal

Book Volume: 77

Pages Range: 116-123

DOI: 10.1016/j.jor.2026.05.016

Abstract

Background: Anterior cruciate ligament (ACL) injuries are among the most common knee injuries. Treatment options include conservative management as well as surgical repair and reconstruction. Given the well-documented risk of secondary joint damage, such as meniscal injury, cartilage degeneration, and the progression to osteoarthritis in persistently unstable knees, ACL reconstruction has become a widely accepted standard of care. Various surgical techniques have been developed. Among these, anteromedial femoral tunnel drilling has gained increasing attention as a more anatomic alternative to the transtibial technique, with the potential to overcome its limitations and improve clinical outcomes. Methods: An umbrella review of meta-analyses was conducted in accordance with established methodological standards. Meta-analyses of randomised controlled trials (RCTs) directly comparing anteromedial (transportal) and transtibial femoral tunnel drilling techniques in primary ACL reconstruction were included. Quantitative data were extracted for patient-reported outcome measures (PROMs) and consistently reported clinical endpoints, including subjective and objective International Knee Documentation Committee (IKDC) scores, Lysholm and Tegner scores, graft failure rates, instrumented laxity, and clinical stability tests (Lachman and pivot-shift tests). Pooled effect estimates with corresponding confidence intervals were calculated using random-effects models. Between-study heterogeneity was assessed using the I² statistic, and the robustness of the findings was evaluated through sensitivity analyses. Results: Four level I meta-analyses were included. Graft failure rates did not differ significantly between anteromedial and transtibial drilling techniques (RR 0.67, 95% CI 0.42–1.09). Functional outcomes were largely comparable, with no significant differences observed in objective IKDC, Lysholm, or Tegner scores; subjective IKDC scores demonstrated only a small advantage for the anteromedial technique (MD 1.02, 95% CI 0.04–2.00). In contrast, anteromedial drilling was consistently associated with improved clinical stability, reflected by higher rates of negative Lachman (RR 1.12, 95% CI 1.05–1.19) and pivot-shift tests (RR 1.17, 95% CI 1.10–1.24). Sensitivity analyses confirmed the robustness of the stability outcomes, whereas functional measures appeared more susceptible to heterogeneity. Conclusions: Anteromedial femoral tunnel drilling in ACL reconstruction confers superior rotational knee stability compared with the transtibial technique; however, this biomechanical advantage fails to translate into clinically meaningful improvements in functional outcomes or patient-reported measures.

Authors with CRIS profile

Involved external institutions

How to cite

APA:

Migliorini, F., Schäfer, L., Pilone, M., Giai Via, R., Betsch, M., & Boosz, P. (2026). Anteromedial drilling improves rotational stability but not clinical outcomes in anterior cruciate ligament reconstruction: an umbrella review of level I meta-analyses. Journal of Orthopaedics, 77, 116-123. https://doi.org/10.1016/j.jor.2026.05.016

MLA:

Migliorini, Filippo, et al. "Anteromedial drilling improves rotational stability but not clinical outcomes in anterior cruciate ligament reconstruction: an umbrella review of level I meta-analyses." Journal of Orthopaedics 77 (2026): 116-123.

BibTeX: Download