Tibial fixation without hardware for anterior cruciate ligament reconstruction: a new technique

Abstract

Introduction Tibial fixation is the weakest link in anterior cruciate ligament (ACL) reconstruction. Optimal or maximal ACL graft fixation in the tibia remains a challenging goal. Also, tibial fixation with implants for ACL reconstruction can be associated with a wide variety of problems such as graft-tunnel mismatch, graft damage, and poor graft fixation using metal or absorbable implants. Patients and methods A total of 15 male patients, average age 22.2 years (range: 18–36 years), were studied from December 2005 to December 2009. Eleven of our patients had associated medial meniscus injury. The causes of ACL injury were sport accidents in 12 patients and road traffic accidents in three patients. The right limb was affected in nine patients and the left limb was affected in six patients. Results Of the 15 patients, two patients were unwilling to or unable to return for assessment. These two patients were stable and had no complications or complaints at the sixth month for the first patient and at the ninth month for the second one. The results of these two patients were reported. but they were excluded from the evaluation, leaving 13 patients for the final assessment. The follow-up duration was 24 months. Subjectively, no patient complained of residual pain or instability and all patients were able to return to full activities as before injury before 12 months. The preoperative Lysholm Knee Score was poor, with a median of 61 (range: 7–95) as would be expected after injury. The median Lysholm Score at 24 months was 95 (range: 70–95). Objectively, all patients regained full extension and the flexion ranged from 120° to 140°. All patients had a solid end point on the Lachman test, with no positive pivot shift test. Conclusion This report describes a new technique for transosseous tibial fixation for ACL grafts of all varieties. This method secures the ACL graft to the tibial metaphyseal bone, followed by knot tying over a bone bridge and augmented with bone block impacted in the tibial tunnel. This technique is a simple, safe, inexpensive, and reproducible alternative for all types of grafts fixation in the tibial tunnel without hardware in ACL reconstruction.