Abstract

This decade-long retrospective cohort study compares the outcomes of transtibial and anatomic ACL reconstruction using hamstring autografts, addressing a critical gap in the evidence for technique selection, particularly in non-athletic populations. Data from 30 patients who underwent transtibial ACL reconstruction (2007-2009) in our clinic were compared with contemporary anatomic technique studies (2013-2023) to assess graft survival, functional outcomes, and complications. Results demonstrated equivalent graft survival rates (93.4% transtibial vs. 94.9% anatomical, p=0.32), though anatomical techniques outperformed in high-demand activities (Tegner scores, p=0.001). No significant differences were observed in patient-reported outcomes (Lysholm: 84.2 vs. 86.7, p=0.18; IKDC: 81.5 vs. 83.1, p=0.21). The transtibial cohort exhibited shorter operative times (87±23.4 vs. 104±18.6 minutes, p

Key words: Anterior cruciate ligament reconstruction, hamstring autograft, transtibial technique, anatomical technique, graft survival, functional outcomes