ACL reconstruction in football players: A nationwide Swedish registry study of anteromedial versus transtibial femoral tunnel techniques
Alexander SandonAbstract
Purpose
To compare anteromedial (AM) portal versus transtibial (TT) femoral drilling techniques in football players undergoing anterior cruciate ligament reconstruction (ACLR), focusing on return‐to‐competition (RTC), match exposure, patient‐reported outcomes (PROMs) and reinjury risk.
Methods
This nationwide cohort study linked the Swedish Knee Ligament Registry with the Swedish Football Association to capture surgical details, verified football participation, and longitudinal PROMs. All index ACLRs in registered football players from 2017–2023 were included. Outcomes were RTC, match exposure, Knee injury and Osteoarthritis Outcome Score and EuroQol 5 dimension score scores at pre‐op, 1, 2 and 5 years, and revision, contralateral, or any second ACL reconstruction. Analyses used t‐tests and χ 2 tests, and Cox regression adjusted for age, sex, injured side, and meniscal and cartilage injury.
Results
A total of 7169 football players were included (AM 6,653; TT 516). Group differences at baseline were small but present (e.g., more women and left‐sided injuries in TT; more meniscal repair and cartilage injury in AM). RTC rates were similar (55.2% AM vs. 56.8% TT), as were time to RTC, total matches played, matches after RTC, seasons played, and competitive level before and after injury. PROMs showed modest 1‐year differences favouring AM that were not observed at 2 years. No differences were observed at 5 years, although based on limited TT data. Reinjury rates were comparable (revision 6.7% AM vs. 7.4% TT; contralateral 4.6% vs. 4.8%; any second ACLR 11.0% vs. 11.8%). Adjusted Cox models showed no association between portal technique and revision (hazard ratio [HR] 0.878, 95% confidence interval [CI] 0.63–1.23) or any second ACLR (HR 0.906, 95% CI 0.70–1.18), with similar findings in RTC‐only analyses.
Conclusion
In a nationwide cohort of football players, AM and TT femoral drilling techniques yielded similar real‐world outcomes: comparable reinjury risk, RTC rates and timing, match exposure, competitive trajectory, and PROMs. For football players undergoing primary ACL reconstruction, both AM and TT techniques are acceptable options.
Level of Evidence
Level III, retrospective cohort study.