Cicatrisation des greffes de DT4 dans le tunnel tibial et dans l’échancrure : évaluation clinique et IRM à 4 ans minimum des DT4 fixés par fixation de suspension versus vis d’interférence

Abstract

Success of ACL reconstruction requires Graft healing in the joint and a solid graft incorporation within the tunnels. Resorbable interference screws (RIS) provide limited tendon-bone contact because much of the tunnel circumference is occupied by the screw itself, while adjustable suspensory fixation (ASF) systems provide larger contact zones and stiffer fixation which favor graft healing. Purpose To evaluate ligamentization of four-strand semitendinosus (4ST) using MRI, fixed with ASF compared to RIS. Study Design Prospective comparative study; Level II. Methods The authors prospectively enrolled 57 patients undergoing primary ACL reconstruction using single bundle 4ST. The femoral graft was fixed using suspensory fixation in all knees. The tibial graft was fixed using ASF in 28 knees and using RIS in 29 knees. The groups were similar in term of age and gender. Minimum 4 years postoperatively, GNRB® knee laxity measurements were taken and MRI scans were performed to assess graft incorporation within the tibial tunnel and in the notch. Results There was not significant difference on the Functional results IKDC and Lysholm. The IKDC Global score A + B 96.4 % was better in the ASF group than in RIS 82.1 % (p = 0.04). Mean side to side Laximetry test was none significant p = 0.18 (−0.13 vs 0.35). Tunnel enlargement was no significant between the two groups 10.7 mm in ASF group and 11.5 mm in RSI group. Howell graft signal assessment in the notch was excellent (Grade I + II) in 91 % of cases in the ASF Group and in 73 % of cases in the RIS group (p = 0.04). In the tibia the SNQ was 2.25 ± 4.05 in the ASF group and 10.28 ± 18.98 in the RIS group (p = 0.02). In the notch the SNQ was 2.57 ± 2.80 in the ASF group and 6.62 ± 10.99 in the RIS group (ns). There were 6 consistent tibial cysts related to the screw (20 %) in the RSI group and no cyst in the ASF group. Conclusion ASF provides more favorable conditions than RIS for incorporation and ligamentization of 4ST grafts within the tibial tunnel with more residual cysts in the RSI group. In the notch, the Howell grade was better in the ASF group, although the SNQ were not significatively better. the objective IKDC Score was significatively better in ASF group, however functionals results are similar.