Anterior Cruciate Ligament Reconstruction Using a Modified Transtibial Technique in Recreational and Professional Athletes: Clinical Outcomes and Return to Sport After a Minimum Follow-Up of 12 Months

Anterior cruciate ligament (ACL) injuries are common among athletes and have a sig-nificant impact on knee stability and performance. Surgical reconstruction is the standard treatment, with the modified transtibial technique emerging as a promising approach for optimal graft positioning and reduced complications.Methods: A retrospective study was conducted on athletes who underwent primary ACL reconstruction using the modified transtibial technique between January 2020 and December 2023. Clinical outcomes were evaluated using the Lysholm score, IKDC subjective score, and objective knee stability assessments (Lachman test, Pivot-shift test, and KT-1000 arthrometer). Return to sport rates and associated factors were analyzed, distinguishing between professional and recreational athletes. Results: A total of 44 athletes were included (37 males, 7 females; mean age 21.2 ± 5.0 years). At a mean follow-up of 27.0 ± 12.2 months, significant improvements were observed in the Lysholm score (from 79.3 ± 8.6 at baseline to 95.4 ± 5.8 at last follow-up, p< 0.0001) and IKDC subjective score (from 78.5 ± 8.6 at baseline to 91.2 ± 7.9 at last follow-up, p< 0.0001). Overall, 88.2% of athletes returned to sports, with 65.9% achieving their preinjury level. Professional athletes had a significantly higher re-turn-to-preinjury-sport rate (79.3%) than recreational athletes (40.0%, p=0.0091). Concomitant meniscus injuries negatively impacted on return-to-sport rates (92.9% vs. 66.7%, p=0.0397). The overall failure rate was 4.6%, with two cases of graft insufficiency or re-rupture. Conclusion: ACL reconstruction using the modified transtibial technique provides favorable clinical outcomes, high return-to-sport rates, and low failure rates, particularly among professional athletes. The preservation of the meniscus plays a crucial role in optimizing postoperative recovery. Future research should focus on long-term outcomes and comparative studies with other ACL reconstruction techniques.