Abstract
BackgroundThe aim was to compare tunnel widening of autogenous hamstring anterior cruciate ligament reconstruction (ACLR) using cortical button versus cross-pin femoral fixation.MethodsThe PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from inception to 11 April 2019. The study included all levels of evidence in studies that reported femoral tunnel widening and compared cortical button and cross-pin femoral fixation for ACLR.ResultsSix studies were included, covering a total of 344 knees. Using transtibial techniques for ACLR, the mean absolute amount of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross-pin fixation (−0.30 mm; 95% confidence interval (CI) −0.56,−0.05 mm; p= 0.02). Using the transtibial technique, the mean relative percentage of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross pin fixation (−5.73%; 95% CI −10.32, −1.14% ; p= 0.01).ConclusionThe present meta-analysis revealed greater widening of the femoral tunnel when using cortical button fixation for hamstring ACLR via the transtibial technique than when using transfemoral cross-pin fixation.
Highlights
Multiple options are available for femoral graft fixation in anterior cruciate ligament (ACL) reconstruction
Inclusion and exclusion criteria The inclusion criteria for the analysis were that the study must have (1) included patients who underwent primary arthroscopic single-bundle ACL reconstruction, using soft-tissue grafts, with cortical button and cross-pin femoral fixation; (2) evaluated tunnel widening using validated imaging tools such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI); and (3) had complete reporting of parameters including means, standard deviations, and sample numbers
Of the 191 knees undergoing transfemoral fixation, the anteromedial portal technique was used in procedures and the transtibial technique in 125; the technique was not mentioned for 17 procedures
Summary
Multiple options are available for femoral graft fixation in anterior cruciate ligament (ACL) reconstruction. The most common techniques for femoral fixation include cortical button fixation, transfemoral cross-pin fixation, and intra-osseous interference screws fixation. Recent meta-analyses have concluded that cortical button femoral fixation for autogenous hamstring ACL reconstruction had no significant difference in terms of. Cortical button fixation allows for greater movement of the graft within the bone tunnel [6]. The present meta-analysis aimed to compare femoral tunnel widening in ACL reconstruction by cortical button fixation versus transfemoral cross pins. The hypothesis was that less widening of the femoral tunnel occurs when transfemoral cross pins are used compared with cortical button fixation. The aim was to compare tunnel widening of autogenous hamstring anterior cruciate ligament reconstruction (ACLR) using cortical button versus cross-pin femoral fixation
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