OBJECTIVETo compare the properties and clinical outcomes of arthroscopic reconstruction of anterior cruciate ligament (ACL) with preservation of remnant through outside-in and transtibial tunel.

METHODSFrom June 2005 to January 2012, 145 patients were treated with arthroscopic reconstruction of ACL with preservation of remnant. Among the patients, 88 patients were treated with outside-in techniques (outside-in group), including 55 males and 33 females, ranging in age from 18 to 52 years, with a mean of (29.22 +/- 7.31) years; 57 patients were treated with transtibial technique (transtibial group), including 35 males and 22 females, ranging in age from 18 to 51 years, with a mean of (29.28 +/- 8.07) years. The Lysholm, VAS and IKDC scores were compared between two groups before operation, after operation and at the latest follow-up time.

RESULTSThe average operation time was (76.94 +/- 10.83) min in the outside-in group, and (70.35 +/- 10.11) min in the transbibial group, there was a significant difference between two groups. There was no significant difference of hydrops articuli scores at the early stage between the two groups (P = 0.065). At follow-up from 18 to 60 months, there were great improvements in the knee stabilities in each group compared with the preoperative data respectively. The Lysholm score improved from 54.75 +/- 10.58 preoperatively to 95.80 +/- 5.16 at the follow-up in the outside-in group; and improved from 52.51 +/- 11.38 preoperatively to 94.86 +/- 5.50 at follow-up in the transtibial group. Additionally, IKDC grades also improved in both groups. However, no significant differences were seen in stabilities shown by pivot shift test, Lachman test and anterior drawer test. And there also no significant differences of Lysholm scores and IKDC grades between two groups after operation.

CONCLUSIONThe outside-in technique has advantages to create an anatomical femoral tunnel easily with minimal intra-articular interference, and disadvantages of complicated manipulation. The transtibial technique is easy to operate and gain time. Using either of responding technique according to the actual situation, satisfactory outcome could be archived.