Abstract
BackgroundBone tunnel enlargement is a phenomenon present in all anterior cruciate ligament (ACL)- reconstruction techniques. It was hypothesized that press-fit fixation using a free autograft bone plug reduces the overall tunnel size in the tibial tunnel.MethodsIn a prospective cohort study twelve patients who underwent primary ACL reconstruction using an autologous quadriceps tendon graft and adding a free bone block for press-fit fixation (PF) in the tibial tunnel were matched to twelve patients who underwent ACL reconstruction with a hamstring graft and interference screw fixation (IF). The diameters of the bone tunnels were analysed by a multiplanar reconstruction technique (MPR) in a CT scan three months postoperatively. Manual and instrumental laxity (Lachman test, Pivot-shift test, Rolimeter) and functional outcome scores (International Knee Documentation Committee sore, Tegner activity level) were measured after one year follow up.ResultsIn the PF group the mean bone tunnel diameter at the level of the joint entrance was not significantly enlarged. One and two centimeter distal to the bone tunnel diameter was reduced by 15 % (p = .001). In the IF group the bone tunnel at the level of the joint entrance was enlarged by 14 % (p = .001). One and two centimeter distal to the joint line the IF group showed a widening of the bone tunnel by 21 % (p < .001) One and two centimeter below the joint line the bone tunnel was smaller in the PF group when compared to the IF group (p < .001). No significant difference for laxity test and functional outcome scores could be shown.ConclusionThis study demonstrates that press-fit fixation with free autologous bone plugs in the tibial tunnel results in significantly smaller diameter of the tibial tunnel compared to interference screw fixation.
Highlights
Bone tunnel enlargement is a phenomenon present in all anterior cruciate ligament (ACL)- reconstruction techniques
For a comparative matched-pairs analysis twelve male patients, who underwent ACL reconstruction using a standardized technique with quadruple semitendinosus graft with interference screw fixation (PLDLLA; MEGAFIX® C; Karl Storz AG) (IF) were selected as a control group
Twenty-four patients were enrolled into the study and received a CT scan three month after surgery, twelve in the press-fit fixation (PF) group and twelve in the IF group
Summary
Bone tunnel enlargement is a phenomenon present in all anterior cruciate ligament (ACL)- reconstruction techniques. In anterior cruciate ligament (ACL) reconstruction bone tunnel enlargement is a phenomenon, which has been observed in a variety of graft fixation techniques [1]. Bone tunnel enlargement does not appear to influence primary graft stability [7], in case of revision it may make the procedure more difficult to perform, as two-stage revision surgery with bone grafting and delayed ligament reconstruction may be necessary [8,9,10]. Surgical techniques for ACL reconstruction reducing the phenomenon of bone tunnel widening are required [11]. Jagodszinski et al reported a decrease of the tibial bone tunnel diameter for a tibial press-fit fixation technique using a xenogenic bone cylinder [19]
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