Arthroscopic anterior cruciate ligament reconstruction using the double press-fit technique: An alternative to interference screw fixation

Abstract

Purpose: Patellar tendon autograft fixation in arthroscopic anterior cruciate ligament reconstruction is commonly accomplished using interference screws. However, improper insertion of the screws may reduce primary stability, injure the posterior femoral cortex, or displace hardware into the joint. Even if placed properly, metallic screws interfere with postoperative magnetic resonance imaging. In case of revision surgery, removing screws may be difficult and leaves bone defects. Type of Study: Retrospective study. Methods: An arthroscopic technique was developed that achieves patellar tendon autograft fixation by press-fit without any supplemental internal fixation. Forty patients were examined clinically and by KT-1000 arthrometer 28.7 months (range, 22 to 40 months) postoperatively. Results: The mean difference in side-to-side laxity was 1.3 mm (SD 2.2) and the results according to the IKDC score were as follows: 7 A, 28 B, 5 C, and 0 D. Conclusions: The double press-fit technique we present avoids all complications related to the use of interference screws and creates an ideal environment for osseous integration of the bone–patellar tendon–bone autograft. Concurrently, it achieves a stable fixation of the autograft and allows early functional rehabilitation. However, fixation strength depends on bone quality and the arthroscopic procedure is demanding.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 9 (November- December), 2002: pp 974–982