Transtibial Versus Anteromedial Portal ACL Reconstruction. Is a Hybrid Approach the Best?

The HTT technique avoids hyperflexion and maintains femoral tunnel orientation and length, similar to the TT technique, but simultaneously achieves anatomic graft positioning.

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Transphyseal Anterior Cruciate Ligament Reconstruction Using Hybrid Transtibial Femoral Drilling and a Quadriceps Tendon Autograft

A hybrid transtibial technique using a Pathfinder guide facilitates femoral drilling with the “best of both worlds,” allowing for reproduction of the native ACL footprint and a more physeal-respecting femoral tunnel. The hybrid transtibial method yields a reliable, safe, and robust construct with promising results for the young athlete.

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A Hybrid Transtibial Technique Combines the Advantages of Anteromedial Portal and Transtibial Approaches – A Prospective Randomized Controlled Trial

The HTT technique achieved femoral aperture positions equally as anatomic as the AM portal technique but produced longer, less angulated femoral tunnels, which may help reduce graft strain and mismatch. As such, this hybrid approach may represent a beneficial combination of both the TT and the AM portal techniques.

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