Abstract
ABSTRACTPurpose:To present a technical variation in tibial fixation of quadruple hamstring grafts during anatomic reconstruction of the anterior cruciate ligament (ACL). The secondary purpose was to decrease the costs associated with this procedure. Methods:Twenty patients who underwent ACL reconstruction were selected. A tibial tunnel was constructed using standard techniques, and a femoral tunnel was anatomically created using the outside-in technique. The hamstring autograft was passed (with its bend) into the tibial tunnel and affixed to the tibia using the suspensory technique and a simple staple. Femoral fixation was performed using a titanium interference screw. The patients underwent postoperative evaluations at 0, 3, 6 and 12 months using the subjective International Knee Documentation Committee (IKDC) form and Lysholm knee scores. Results:The IKDC and Lysholm score results improved over time (p<0.001) without major complications. The cost of the procedure could be reduced by using lower-cost hardware (staples). Conclusion:The proposed technique for anatomic ACL reconstruction using inverted hamstring grafts with their bend in the tibial tunnel, suspension-type fixation using a staple demonstrated good to excellent results after 1 year of follow up, with lower aggregate costs. Level of Evidence IV; Case series.
Highlights
Anterior cruciate ligament (ACL) injuries are frequent in active young people and can potentially cause instability and reduce knee function.[1]
The proposed technique for anatomic anterior cruciate ligament (ACL) reconstruction using inverted hamstring grafts with their bend in the tibial tunnel, suspension-type fixation using a staple demonstrated good to excellent results after 1 year of follow up, with lower aggregate costs
Surgical treatment is recommended when patients complain of instability and to prevent associated injuries.[2]. This treatment is so widely accepted that approximately 100,000 ACL reconstructions are performed each year in the United States,[3] and more than 90% of these surgeries yield good to excellent results.[4]
Summary
Anterior cruciate ligament (ACL) injuries are frequent in active young people and can potentially cause instability and reduce knee function.[1] Surgical treatment is recommended when patients complain of instability and to prevent associated injuries.[2] This treatment is so widely accepted that approximately 100,000 ACL reconstructions are performed each year in the United States,[3] and more than 90% of these surgeries yield good to excellent results.[4]. Cournapeau et al.[5] showed that much of the costs of ACL reconstruction are related to disposable arthroscopy materials and implants; the high incidence of this procedure raises concerns about its costs. Using the data on incidence in the United States as an example
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