Femoral Fixation Devices Research Articles

Comparison of Cross-Pin Versus Cortical Button Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft: A Long-Term Clinical Study and Review of the Literature.

Background Anterior cruciate ligament reconstruction (ACLR) is a common operative procedure and many options regarding the type of the selected graft and fixation technique have been described to date. Although many studies have addressed the issue of the optimal femoral fixation device during ACLR with a hamstring tendon (HT) autograft, no clear evidence to indicate one technique over another has been found. Objective The purpose of this study was to compare the long-term postoperative outcomes and complication rates between transfemoral Cross-pin (CP) and Endobutton-Cortical Button (CB) fixation techniques in patients undergoing ACLR with an HT autograft. Methods One hundred and seven consecutive patients underwent ACLR by using a quadruple HT autograft that was stabilized with either a CP (CP Group: 52 patients) or a CB (CB Group: 55 patients) fixation technique. The Lachman test (LT), the Pivot-shift test (PST), the side-to-side difference in anterior translation of the tibia, the International Knee Documentation Committee (IKDC), and the Lysholm knee scoring systems were evaluated before surgery and during long-term follow up. Thefemoral and tibial tunnel diameter was measured in the anteroposterior (AP) and lateral radiographsafter surgery and at the final follow-up. Areview of the literature was also carried out to identify any differences between both techniques. Results Study groups were comparable in terms of patient demographics. The mean follow-up was 10.4 ± 1.3 and 10.6 ± 1.3 years in the CP and CB Groups, respectively (p = 0.47). In the CP Group, improvements after surgery in LT and PST from grade 2 (n=34) or 3 (n=18) to grade 0 (n = 41) or 1 (n = 11) and from grade 2 (n=36) or 3 (n = 16) to grade 0 (n = 44) or 1 (n = 8), respectively, were observed. In the CB Group, similar improvements in LT and PST scores from grade 2 (n = 40) or 3 (n = 15) to grade 0 (n = 46) or 1 (n = 9) and from grade 2 (n = 41) or 3 (n = 14) to grade 0 (n = 47) or 1 (n = 8), respectively, were observed. However, no differences between the groups (p = 0.53 for LT and p = 0.90 for PST) were noted. The mean Lysholm scores were 89.7 ± 6.8 and 90.2 ± 7.2 in the CP and CB groups, respectively (p = 0.59). Side-to-side difference improved from 9.1 ± 2.8 to 1.7 ± 1.5 mm and from 8.6 ± 2.5 to 1.6 ± 1.4 mm in the CP and CB groups, respectively (p = 0.89 between groups). According to IKDC grades, 92.1% and 91.4% of knees in the CP and CB groups, respectively were reported to be Grade A (Normal) or B (Nearly Normal) with a p = 0.7. Femoral and tibial tunnel widening was found in the last follow-up in both groups. However, there was no difference in the degree of tunnel widening among the two techniques.With respect to LT, PST, anterior drawer test, and IKDC score, none of the 15 published comparative studies demonstrated any significant differences between the two techniques and only one study detected a difference regarding the Lysholm score in favor of CP fixation. Conclusion In the long term, both CB and CP femoral stabilization techniques were shown to be associated with similar functional outcomes and low complication rates. Further large multicenter random clinical trials are still required to identify the most effective method of femoral fixation for HT autograft during ACLR surgery.

A lateral extra-articular tenodesis without additional hardware: Surgical technique and biomechanical comparison with an anatomic anterolateral ligament reconstruction in the augmentation of anterior cruciate ligament reconstruction

BackgroundThe aims of this study were to describe a lateral extra-articular tenodesis (LET) using no additional hardware and compare the tibiofemoral kinematics of anterior cruciate ligament (ACL) reconstruction augmented with either the LET or a standard anatomic anterolateral ligament (ALL) reconstruction using intra-tunnel fixation. MethodsTen cadaveric knees were mounted on a robotic testing system and underwent a kinematic assessment of anterior tibial translation and internal tibial rotation under a simulated pivot-shift in the following states: ACL-intact, ACL-sectioned, ACL-sectioned/anterolateral complex (ALC)-sectioned, ACL-reconstructed/ALC-sectioned, ACL-reconstructed/ALL-reconstructed, and ACL-reconstructed/LET. For the LET, an iliotibial autograft was passed under the fibular collateral ligament and secured to the femur with the pull sutures of the ACL reconstruction femoral cortical suspensory fixation device, positioned at the distal ridge of Kaplan’s fibers. ResultsAnterior tibial translation was restored to normal by ACL reconstruction without meaningful benefit of augmentation with LET or ALL. ACL reconstruction restored internal tibial rotation close to normal between 0° and 30°, but increased internal tibial rotation persisted between 45° and 90°. Augmentation of ACL reconstruction with the LET reduced internal rotation close to normal between 45° and 90°, whereas increased internal rotation persisted after ALL reconstruction. ConclusionACL reconstruction and LET are complementary in controlling tibiofemoral kinematics of knees with a combined ACL and ALC injury: ACL reconstruction restored native tibiofemoral kinematics except for internal rotation at flexion greater than 30°. The increased internal rotation at flexion greater than 30° was restored to normal with an LET, but not with an ALL reconstruction.

...Functional Outcomes After Anterior Cruciate Ligament Reconstruction Using Adjustable Femoral Cortical Suspensory Fixation Device

...Functional Outcomes After Anterior Cruciate Ligament Reconstruction Using Adjustable Femoral Cortical Suspensory Fixation Device

A randomised controlled study for the comparison of functional outcome of femoral tunnel fixation devices, aperture fixation by screw vs suspensory fixation by endo-button in arthroscopic anterior cruciate ligament reconstruction

: The goal of this study was to compare suspensory and aperture fixation methods for restoring soft tissue allografts in the anterior cruciate ligament (ACL).: 30 patients were chosen and randomly allocated to one of two experimental groups, suspensory fixation or aperture fixation, following the completion of a prospective analysis, permission from the institutional review board, and patient agreement. All of the patients underwent ACL reconstruction surgery using soft tissue allografts made of hamstring tendon. The procedures were either (1) femoral and tibial fixation with a femoral cannulated interference screw and a tibial cannulated interference screw (aperture) or (2) femoral cortical buttons (suspensory) and a tibial cannulated interference screw. The subjective anterior drawer test analysis and changes in the International Knee Documentation Committee knee examination rating were employed as end measures.: All of the patients who had received treatment (100%) had successfully completed a clinical assessment at the 1-month, 4-month, 8-month, and 12-month follow-ups. Out of the 30 patients who were included, 15 (50%) underwent suspensory fixation treatment and the other 15 (50%) underwent aperture fixation treatment. The primary outcome measure—AP stability at 25 degrees of knee flexion—did not differ across groups at a 12-month follow-up. Also, at the 1-month and 4-month evaluations, secondary data revealed a statistically significant difference between the groups.: Our data showed no meaningful differences in knee AP stability or other outcomes between ACL allograft reconstruction using aperture fixation and ACL allograft reconstruction utilising suspensory fixation at the 12-month mark, while aperture fixation performed better at the first and fourth months. One of our main outcome measures was the grading of knee anteroposterior (AP) stability (clinical judgments).: Level II, lesser-quality randomised controlled trial with a follow-up of 1 year.

Development and validation of a deep learning model using convolutional neural networks to identify femoral internal fixation device in radiographs.

The purpose of this study is to develop and validate a deep convolutional neural network (DCNN) model to automatically identify the manufacturer and model of hip internal fixation devices from anteroposterior (AP) radiographs. In this retrospective study, 1721 hip AP radiographs, including six internal fixation devices from 1012 patients, were collected from an orthopedic center between June 2014 and June 2022 to establish a classification network. The images were divided into training set (1106 images), validation set (272 images), and test set (343 images). The model efficacy is evaluated by using the data on the test set. The overall TOP-1 accuracy, and the precision, sensitivity, specificity, and F1 score of each model are calculated, and receiver operating characteristic (ROC) curves are plotted to evaluate the model performance. Gradient-weighted class activation mapping (Grad-CAM) images are used to determine the image features that are most important for DCNN decisions. A total of 1378 (80%) images were used for model development, and model efficacy was validated on a test set with 343 (20%) images. The overall TOP-1 accuracy was 98.5%. The area under the receiver operating characteristic curve (AUC) values for each internal fixation model were 1.000, 1.000, 0.980, 1.000, 0.999, and 1.000, respectively. Gradient-weighted class activation mapping showed the unique design of the internal fixation device. We developed a deep convolutional neural network model that can identify the manufacturer and model of hip internal fixation devices from the hip AP radiographs.

Does loop length change after anterior cruciate ligament reconstruction with adjustable loop cortical suspension device?: Observation of the hamstring graft completely filling the femoral tunnel

PurposeThe adjustable loop cortical suspension device (ALD) is a useful femoral fixation device in anterior cruciate ligament (ACL) reconstructions, but the possibility of loosening has been suggested. The purpose of this study was to evaluate the elongation of an adjustable loop and the position of the hamstring graft inside the femoral socket.MethodsThe subjects were 33 patients who underwent ACL reconstruction with a hamstring tendon. The graft was fixed using ALD and completely filled the femoral socket. Magnetic resonance images were taken one week and one year after the operation. The loop length, femoral socket length, and graft length inside the socket were measured and statistically compared with the clinical outcomes.ResultsThe loop length one week after surgery was 18.9 ± 4.4 mm, and 1 year after surgery was 19.9 ± 4.5 mm (P < 0.001). The gap between the top of the graft and femoral socket was 0.9 ± 1.8 mm one week after surgery and 1.3 ± 1.7 mm one year after surgery (P = 0.259). At one week post-operation, a gap was found in nine patients (27.3%). The loop length and gap did not strongly correlate with clinical findings.ConclusionACL reconstruction using ALD showed a gap between the graft and femoral socket at the one week post-operation mark in 27.3% of participants. One year after the surgery, there were cases where the gap increased and/or decreased, but the elongation of the loop was 1 mm on average. Our findings suggest that ALD is clinically safe to use; however, has the possibility of initial loop elongation and non-uniform changes.Level of evidenceIV.

Outcome analysis of arthroscopic reconstruction of anterior cruciate ligament in adults

Background: Anterior cruciate ligament injury is the common knee injury consequent to contact sports. There are different techniques recommended for the ACL reconstruction, with different graft materials. The aim of this study is to evaluate the functional outcome of arthroscopic single bundle ACL reconstruction using hamstring tendon graft in ACL deficient knees in adults. AIM: To evaluate the functional outcome of arthroscopic single bundle anterior cruciate ligament reconstruction using quadrupled hamstring tendon (Gracilis and semitendinosus) autograft with endobutton as femoral fixation device and interference screw as tibial fixation device in ACL deficient knees in adults. Methodology: Between December 2020 to December 2022, a prospective study was conducted in Government Medical College, Kota on 21 ACL deficient patients (M =19, F = 2] but 1 male patient was lost to follow-up. All patients were evaluated pre-operatively using the Lysholm & Gillquist score and IKDC – 2000 score. All patients underwent arthroscopic single bundle ACL reconstruction with hamstring tendon graft, which was fixed with an endobutton fixation system on the femoral side and an interference screw on tibial side. They were advised a regular rehabilitation protocol. All patients were evaluated post-operatively at 6 weeks, 3 months, 6 months and a year by same assessment scores. Results: 20 patients were available for follow up for a period of 6 months to 2 years. The mean follow-up period was 10.5 months. When compared with their respective pre-operative knee assessment scores, it was found that a definite improvement was there in their knee function. The results were good to excellent in 80% patients and fair in 20%. Conclusion: For young active adults, single bundle reconstruction by arthroscopic methods gives acceptable results. The problems which are faced post-operatively can be again settled arthroscopically. A long term follow-up of these cases is a must to analyze if there is degeneration that happened in the time between injury and ligament reconstruction.

Isokinetic Muscle Strength and Knee Function in Anatomical Anterior Cruciate Ligament Reconstruction With Hamstring Autografts: A Prospective Randomized Comparative Study Between Suspensory and Expandable Femoral Fixation in Male Patients.

Background Clinical performance, anterior knee stability, and isokinetic strength after anterior cruciate ligament (ACL) reconstruction with hamstring autografts are mainly influenced by graft selection, femoral tunnel preparation, and type of femoral fixation.Expandable femoral fixation devices are expected to provide a stronger initial fixation with circular graft compression, a blind-ended tunnel in the femur with less enlargement, and a theoretical double-band ACL equivalent through graft rotation. This study aimed to evaluate isokinetic strength and functional capacity after ACL reconstruction with hamstring tendons using two different anatomical femoral fixation techniques (expandable vs fixed-looped button). Methodology A total of 48 male patients with ACL deficient knees were randomized to two different femoral fixation groups, namely, the expandable (AperFix) and the standard cortical (Button) group. The primary outcome measures were isokinetic hamstrings and quadriceps strength capabilities and the hamstrings/quadriceps ratio at 60 degrees/second (°/s) and 180°/s using a Cybex before and at three, six, nine, 12, and 24 months after surgery. Secondary measurements were anteroposterior knee stability at two years (using KT-1000 arthrometer) and the functional outcome using the International Knee Documentation Committee (IKDC 2000) form, the Tegner activity scale, and the Lysholm knee score. Data were compared using a paired t-test and analysis of variance, with a p < 0.05 level of significance. Results Most patients regained the 60°/s quadriceps strength between three and 12 months (62.5% for the Button group vs. 50% for the AperFix group), as well as the 180°/s strength (79.17% vs 70.83%); however, at the 24-month evaluation, seven (29.17%) patients in the Button group and five (20.83%) in the AperFix group had significant deficits. The 60°/s flexor strength was regained in the first six months in 19 (79.17%)patients in the Button group and in 16 (66.7%)patients in the AperFix group, whereas the percentages for the 180°/s strength were 79.17% and 75%, respectively. Beyond the 24-month evaluation, only three (12.5%) patients in the Button group and four (16.67%) in the AperFix group had significant flexor deficits. Regarding the H/Q ratio, at 60°/s, the mean recovery time was six and 7.5 months for the Button and AperFix groups, respectively, whereas 15 and 12 patients, respectively, did not recover during the two-year duration. At 180°/s, a mean recovery time of six months was needed for the button group, and nine patients did not recover two years later. For the AperFix group, nine months were needed, and 12 patients did not recover in two years. Clinical performance and anterior knee stability showed no statistically significant differences between groups. Conclusions Although there were no significant differences in clinical performance, knee stability, and isokinetic strength testing between expandable and cortical button femoral fixation groups, return to play was doubtful at two years postoperatively.

Arthroscopic Visualization of Femoral Cortical Button Deployment During Anterior Cruciate Ligament Reconstruction

Background: Up to 25% of femoral cortical suspensory fixation devices are reported to be deployed inappropriately during anterior cruciate ligament (ACL) reconstruction. Most techniques for visualizing suspensory button deployment reported in the literature are for adjustable loop buttons and outside-in femoral tunnel technique. Intraoperative radiographs are inconvenient and involve exposure to radiation. No “gold standard” technique for visualization of femoral cortical button deployment has been described yet. Indications: This technique can be employed for all patients requiring ACL reconstruction surgery. Technique Description: The femoral tunnel is prepared from the anteromedial portal. With the knee in flexion, a beath pin loaded with a suture loop is passed via the anteromedial portal through the femoral tunnel; the eyelet of the pin with the suture loop is retained in the femoral tunnel. The knee is extended without fear of bending the beath pin. The arthroscope is shifted into the lateral gutter. An outside-in lateral parapatellar portal is made at the level of the center of the patella, 1 cm lateral to its lateral edge. The joint capsule and soft tissues in the lateral gutter are resected using a shaver. The beath pin is identified without fear of lacerating the suture loop. The exit point of the pin depends on the knee flexion at the time of femoral tunnel preparation, and more flexion results in more anterior pin exit and vice versa. The rest of the surgery is performed as planned. The definitive sutures of the desired femoral cortical suspensory device are passed from the tibial tunnel into the femoral tunnel. The arthroscope is then positioned in the lateral gutter and the cortical button is deployed appropriately under vision, onto the lateral femoral cortex. If required, the cortical button can be manipulated to seat it appropriately, using an instrument from the lateral parapatellar portal. The remainder of the surgery is performed as per the surgeon’s preference. Results: We routinely perform this step during ACL reconstruction. It adds 2 to 4 minutes to the surgical time. We have not encountered any complications of this procedure. Discussion/Conclusion: This maneuver is effective in facilitating appropriate deployment of femoral cortical suspensory devices under vision.

Safe femoral condyle range for the reverse Rigidfix femoral fixation device in anterior cruciate ligament reconstruction

BackgroundTo determine the characteristics of cross-pin protrusion in patients treated with the reverse Rigidfix femoral fixation device for femoral tunnel preparation through the anteromedial portal in Arthroscopic anterior cruciate ligament reconstruction (ACLR), analyse the reasons for this outcome, and identify safety hazards of this surgical technique for improvement.MethodsA retrospective analysis of patients who underwent ACLR using this technology at our hospital in 2018 was conducted. Patients with and without cross-pin protrusion were included in the protrusion positive and negative groups, respectively. The sex, age and imaging characteristics of the patients with cross-pin protrusion were identified, and the reasons for cross-pin protrusion were analysed.ResultsThere were 64 and 212 patients in the protrusion positive and negative groups, respectively. The proportion of cross-pin protrusion cases was 23.19% (64/276). There was a significant difference in the ratio of males to females (P < 0.001, χ2 = 185.184), the mediolateral femoral condyle diameter (protrusion positive group, 70.59 ± 2.51 mm; protrusion negative group, 82.65 ± 4.16 mm; P < 0.001, t = 28.424), and the anteroposterior diameter of the lateral femoral condyle (protrusion positive group, 58.34 ± 2.89 mm; protrusion negative group, 66.38 ± 3.53 mm; P < 0.001, t = 16.615). The cross-pins did not penetrate the lateral femoral condyle cortex in patients with a mediolateral femoral condyle diameter ≥ 76 mm, but the cross-pins definitely penetrated the cortex when the diameter was ≤ 70 mm. The cross-pins did not penetrate when the anteroposterior lateral femoral condyle diameter was ≥ 66 mm, but the cross-pins definitely penetrated it when the diameter was ≤ 59 mm.ConclusionThe patients with cross-pin protrusion after reverse Rigidfix femoral fixation treatment to prepare the femoral tunnel through the anteromedial portal in ACLR were mainly females with small femoral condyles. For patients with a mediolateral femoral condyle diameter ≥ 76 mm and an anteroposterior lateral femoral condyle diameter ≥ 66 mm, there is no risk of cross-pin protrusion, so this technique can be used with confidence.Levels of evidenceIII.

Suspensory Versus Interference Tibial Fixation of Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction: Results From the New Zealand ACL Registry

Background: The hamstring tendon is frequently used to reconstruct the anterior cruciate ligament (ACL), but there is a lack of consensus on the optimal method of fixation. Registry studies have shown that the type of femoral fixation device can influence the risk of revision ACL reconstruction (ACLR), but it is unclear whether the type of tibial fixation has an effect. In New Zealand, over 95% of hamstring tendon grafts are fixed with an adjustable loop suspensory device on the femoral side, with variable usage between suspensory and interference devices, with or without a sheath, on the tibial side. Purpose: To investigate the association between the type of tibial fixation device and the risk of revision ACLR. Study Design: Cohort Study; Level of evidence, 2. Methods: Prospective data recorded in the New Zealand ACL Registry were analyzed. Only primary ACLRs performed with a hamstring tendon autograft fixed with a suspensory device on the femoral side were included. A Cox regression survival analysis with adjustment for patient factors was performed to analyze the effects of the type of tibial fixation device, the number of graft strands, and graft diameter on the risk of revision. Results: A total of 6145 primary ACLRs performed between 2014 and 2019 were analyzed. A total of 59.6% of hamstring tendon autografts were fixed with a suspensory device on the tibial side (n = 3662), 17.6% with an interference screw with a sheath (n = 1079), and 22.8% with an interference screw without a sheath (n = 1404). When compared with suspensory devices, a higher revision risk was observed when using an interference screw with a sheath (adjusted hazard ratio [HR], 2.05; P = .009) and without a sheath (adjusted HR, 1.81; P = .044). The number of graft strands and a graft diameter of ≥8 mm were associated with the rate of revision on the univariate analysis; however, after adjusting for confounding variables on the multivariate analysis, they did not significantly influence the risk of revision. Conclusion: In this study of hamstring tendon autografts fixed with an adjustable loop suspensory device on the femoral side during primary ACLR, the use of an interference screw, with or without a sheath, on the tibial side resulted in a higher revision rate when compared with a suspensory device.

CORRELATION OF FUNCTIONAL STATUS OF ARTHROSCOPIC ACL RECONSTRUCTION FOR PREVENTION OF TITANIUM INTERFERENCE SCREW

INTRODUCTION: Due to an increase in traffic accidents and more common people participating in sports-related activities, knee injuries are more frequent today. The knee's anterior cruciate ligament is the ligament that gets injured the most frequently. The principal stabiliser that prevents the anterior translation of the tibia over the femur is the anterior cruciate ligament, which plays a pivotal role in the stability and function of the knee joint. The gold standard for treating these injuries is arthroscopic anterior cruciate ligament reconstruction. Methods: This study is a retrospective and prospective analysis of 60 patients who underwent arthroscopic reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft with an endobutton as the femoral fixation device and a titanium interference screw (no=30) or a bioabsorbable interference screw (no=30) as the tibial fixation device. Results: This study is a retrospective and prospective analysis of 60 patients who underwent arthroscopic reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft with an endobutton as the femoral fixation device and a titanium interference screw (no=30) or a bioabsorbable interference screw (no=30) as the tibial fixation device. CONCLUSION: Clinical outcomes for interference screws made of titanium and bioabsorbable material are statistically comparable. The two screws' complication rates were comparable as well. This comparison analysis's findings are consistent with the claim that titanium screws and bioabsorbable screws both produce comparable results when used for ACL restoration.

Anterior cruciate ligament reconstruction with short hamstring grafts: the choice of femoral fixation device matters in controlling overall lengthening.

The purpose was to conduct an independent biomechanical study comparing the main types of femoral fixation adapted to short hamstring grafts in anterior cruciate ligament (ACL) reconstruction surgery and to validate their performance. The ACLip® Femoral, ToggleLoc™ Ziploop (TLZ), and Tape Locking Screw (TLS®) implants were tested in tension in the following three different configurations: implant alone, implant fixed on the femur without graft, and implant fixed on the femur with graft. Grafts alone were also tested. The femurs and the 4-strand semi-tendinosus grafts were derived from porcine and human models, respectively. Each set-up was subjected to the same protocol of creep (50N for 30s), cycling (1000 cycles between 50 and 250N, 1Hz), and load to failure (50mm/min). A total of 93 tests were performed (30 ACLip®, 30 TLZ, 20 TLS®, and 13 ST4 alone). For the implants tested with femur and graft, the mean ± standard deviation (SD) overall elongation at 250N after cycling was 5.2 ± 0.2mm, 8.4 ± 2.1mm, and 5.3 ± 0.8mm, the mean ± SD ultimate load to failure was 736 ± 116N, 830 ± 204N, and 640 ± 242N, and the mean ± SD stiffness at the 1000th cycle was 185 ± 15N/mm, 172 ± 19N/mm, and 178 ± 21N/mm for ACLip®, ToggleLoc™, and TLS® devices, respectively. There was no significant difference between the implants except for post-cycling elongation between TLZ and the other two implants (p < 0.05). The choice of femoral fixation device plays a decisive role in controlling the overall lengthening of an ACL reconstruction using a short hamstring graft. All implants validated the specifications in terms of ultimate load to failure, the TLS® system had, however, a low performance limit. ToggleLoc™ with adjustable loop should no longer be used on the femur side; instead the other types of fixation should be used to improve the overall elongation control.

Graft Failure in Adolescent Patients Undergoing Adult-Type ACL Reconstruction with Bone Patellar Tendon Bone or Hamstring Autograft

Introduction:Anterior cruciate ligament (ACL) injuries represent a quarter of high school knee injuries. Adult-type ACL reconstruction (ACL-R) is the treatment of choice for skeletally mature adolescent patients with a complete ACL tear. Graft choice is individualized to the patient, taking into account the patient’s anatomy, activity level, and athletic participation. This subset of patients is at perhaps the highest risk of failure due to demands on the reconstruction after surgery.Hypothesis/Purpose:The purpose of this study was to evaluate outcomes including graft rupture between bone-patellar tendon-bone (BTB) versus hamstring autograft in adolescent patients undergoing adult-type ACL reconstruction.Methods:A retrospective review of patients under the age of 21 undergoing primary adult-type ACL-R by a single surgeon using BTB or hamstring autograft between 2011 and 2019 was performed. Patient demographics, athletic participation, concomitant injuries, graft utilized, graft size, femoral and tibial fixation devices, compliance with rehabilitation protocol, complications, and rates of revision surgery were evaluated. Factors associated with graft failure were compared using Fisher’s exact test with statistical significance < 0.05.Results:269 patients with an average age of 16.5 years (range 12.4-20.6) and an average follow-up of 2.1 years (range 0.4-6.6 years) were included. 52.5% of the patients were female. The overall graft rupture rate was 4.8%. There was no difference in average age, sex, compliance, and participation in high risk sports between graft type groups. Graft size was larger in patients with BTB autograft than patients with hamstring autograft (9.0 vs. 8.3; p<.001). There was no difference in the overall rate of re-operation between BTB and hamstring autografts (8.6% vs. 10.6%; p=0.81). There was no significant difference in rate of graft rupture with BTB and hamstring autograft (2.9% vs. 5.5%; p=0.26). Average time to revision surgery in those with ruptures was 1.7 years (range 0.7-4.7 years). 46% of patients had revision ACL-R with a different surgeon. There was no difference in age or participation in high risk sports between patients with and without graft tear. There was a higher percentage of documented compliance issues in patients with graft tear (46%) than without graft tear (29%), though not statistically significant (p=0.17).Conclusion:Rates of graft tear after ACL-R did not differ with BTB versus hamstring autograft. Rates of compliance and participation in high risk sports did not significantly differ in patients with and without graft tear. Many patients had a change in surgical provider for revision surgery.

Randomized comparative study of suspension femoral fixation device in graft position maintenance in anterior cruciate ligament reconstruction: EndoButton CL vs TightRope RT

BackgroundIn double-bundle anterior cruciate ligament reconstruction (ACLR), fixed-loop and adjustable-loop cortical suspensory devices are commonly used to fix the soft graft on the femoral side. However, few studies have compared in vivo elongation of the two devices. The purpose of this study was to determine whether EndoButton CL (EB) and TightRope RT (TR), the suspensory fixation devices used in ACLR, maintained their length in vivo from the time of surgery through the postoperative period in a randomized controlled trial. MethodsThis study prospectively incorporated 30 patients undergoing initial ACLR at a single center. Participants were divided into two groups using a stratified randomization method with age and sex as assignment adjustment factors. EB or TR was used for fixation of the soft graft on the femoral side. The primary endpoint was to compare the elongation distance of the suspensory device. MRIs were taken within seven days after ACLR and 3,6,12 months postoperatively and measured by a radiologist in a blinded fashion. Secondary endpoints included the side-to-side difference in anterior translation, one leg hop test (HOP index), Lachman test, lateral pivot shift test, and Lysholm score one year postoperatively. ResultsTwenty-eight patients (EB, n = 13; TR, n = 15) were followed for one year. There was no significant difference between EB and TR groups in elongation from the immediate postoperative period to 3, 6, 12 months after surgery. However, the non-inferiority of TR to EB (non-inferiority margin: 1.5 mm) was not proved by the difference in measured elongation between the two groups (TR – EB, lower 95% CI. AM: 1.80 mm; PL: 1.86 mm) at 6 months. There was no significant difference in anterior translation, HOP index, Lachman test, lateral pivot shift test, or Lysholm score. ConclusionEB and TR had similar graft retaining ability in vivo for 12 months, but the non-inferiority of TR against EB was not verified statistically.

Anatomical rectangular tunnel anterior cruciate ligament reconstruction provides excellent clinical outcomes.

The purpose of this study was to prospectively evaluate the clinical outcomes following anatomical rectangular tunnel anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BTB) graft using an adjustable-length femoral cortical fixation device with enough patients and a high follow-up rate. This study included 125 patients who underwent anatomical rectangular tunnel ACL reconstruction with a BTB graft. A BTB TightRope® was used for femoral graft fixation. Clinical evaluations were performed more than 2years after surgery using the International Knee Documentation Committee (IKDC) Form. Patients interviewed by telephone were only subjectively evaluated. The side-to-side difference in anterior laxity at a manual maximum force was measured using the KT-2000 Arthrometer®. Among the 125 patients, 99 were ultimately included and 26 were lost to follow-up (follow-up rate: 79%). Eight patients had re-tear (re-tear rate: 8%) and six patients had ACL injuries to the contralateral knee. Three patients did not follow our rehabilitation programme. One patient suffered septic arthritis. These 18 patients were considered ineligible for clinical evaluations. Therefore, clinical evaluations were performed in 81 of the 99 patients (64 were available for direct follow-up and 17 were available for a telephone interview). The follow-up period was 30 ± 10months (range 24-68months). According to the IKDC subjective assessment, 48 (59%) and 33 (41%) knees were graded as normal and nearly normal, respectively. A loss of extension (3°-5°) was observed in five patients (8%), whereas one patient (2%) exhibited a loss of flexion (3°-5°). The Lachman test was negative in 63 patients (98%). The pivot shift test was negative in 59 patients (92%). The side-to-side difference in KT value was 0.4 ± 0.7mm (range - 1-4mm). Anatomical rectangular tunnel ACL reconstruction with a BTB graft using an adjustable-length femoral cortical fixation device provided excellent clinical outcomes both subjectively and objectively more than 2years after surgery, whereas 8 of the 99 patients had re-tear of the graft. The adjustable-length femoral cortical fixation device could be safely used in anatomical rectangular tunnel ACL reconstruction with a BTB graft. III.

Les longueurs intra-articulaires des greffons à double faisceau peuvent changer pendant la flexion du genou : mesures peropératoires lors de reconstructions anatomiques du ligament croisé antérieur

BackgroundThe lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion during double-bundle anterior cruciate ligament (ACL) reconstruction. However, the actual intra-articular graft length would be affected by the bone tunnel position and tunnel creation angle during ACL reconstruction. The aim of this study was to investigate the intra-articular length change of the AMB and PLB in patients who underwent anatomic double-bundle ACL reconstruction. HypothesisWe hypothesized that the PLB would show a more dynamic length change pattern than the AMB during knee flexion at ACL reconstruction. MethodsThirty-two patients (16 men and 16 women) who had isolated ACL injuries with intact menisci were investigated. Anatomic double-bundle ACL reconstructions were performed using semitendinosus tendon autografts at a mean age of 30.6 years. The graft and tunnel lengths were measured intraoperatively. Intra-articular graft lengths and length changes were calculated at 0° and 90° of knee flexion during ACL reconstruction. Intraoperative data were collected prospectively, and analyses were performed retrospectively. ResultsThe intra-articular length of the AMB at 0° of knee flexion was 28.1±5.5mm. At 90° of knee flexion, the AMB intra-articular length decreased to 25.6±4.8mm. The intra-articular length of the PLB decreased to 17.7±4.6mm at 90° of knee flexion compared to 22.0±4.2mm at 0° of knee flexion. Changes in the intra-articular graft length during knee flexion were detected more in the PLB (4.1mm) than in the AMB (2.0mm, p=0.01). DiscussionThis study demonstrated that the intra-articular length change of the PLB during knee motion was larger than that of the AMB in anatomic double-bundle ACL reconstructions with semitendinosus tendon autografts and suspensory femoral fixation devices. Level of evidenceIV ; retrospective cohort study.

Intraarticular lengths of double-bundle grafts can change during knee flexion: Intraoperative measurements in anatomic anterior cruciate ligament reconstructions

BackgroundThe lengths of the anteromedial bundle (AMB) and posterolateral bundle (PLB) change during knee motion in double-bundle anterior cruciate ligament (ACL) reconstruction. However, the actual intraarticular graft length would be affected by the bone tunnel position and tunnel creation angle during ACL reconstruction. The aim of this study was to investigate the intraarticular length change of the AMB and PLB in patients who underwent anatomic double-bundle ACL reconstruction. HypothesisWe hypothesized that the PLB would show a more dynamic length change pattern than the AMB during knee flexion at ACL reconstruction. MethodsThirty-two patients (16 men and 16 women) who had isolated ACL injuries with intact menisci were investigated. Anatomic double-bundle ACL reconstructions were performed using semitendinosus tendon autografts at a mean age of 30.6 years. The graft and tunnel lengths were measured intraoperatively. Intraarticular graft lengths and length changes were calculated at 0° and 90° of knee flexion during ACL reconstruction. Intraoperative data were collected prospectively, and analyses were performed retrospectively. ResultsThe intraarticular length of the AMB at 0° of knee flexion was 28.1±5.5mm. At 90° of knee flexion, the AMB intraarticular length decreased to 25.6±4.8mm. The intraarticular length of the PLB decreased to 17.7±4.6mm at 90° of knee flexion compared to 22.0±4.2mm at 0° of knee flexion. Changes in the intraarticular graft length during knee flexion were detected more in the PLB (4.1mm) than in the AMB (2.0mm, p=0.01). DiscussionThis study demonstrated that the intraarticular length change of the PLB during knee motion was larger than that of the AMB in anatomic double-bundle ACL reconstructions with semitendinosus tendon autografts and suspensory femoral fixation devices. Level of evidenceIV; retrospective cohort study.

Comparision of functional outcome of arthroscopic anterior cruciate ligament reconstruction using quadrupled semitendinosus and gracilis graft fixed with bioabsorbable interference screw against titanium interference screw

Background: Knee injuries are more common due to exponential increase in road traffic accidents and more involvement in sports related activities by common people. Anterior cruciate ligament injury is one of the most common injuries around knee and poses quiet a lot management controversy. Aims and Objectives: To do comparative analysis of the functional outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction using quadrupled semitendinosus and gracilis graft with endobutton as femoral fixation device and bioabsorbable interference screw against titanium interference screw as tibial fixation devices respectively. Materials and Methods: 60 Patients with ACL tear attending out patient department of a tertiary care hospital were recruited in this prospective, comparative study. Detailed proforma consisting of patient information, Lysholm and Gillquist scoring scale were administered pre and postoperatively for patient. The difference in clinical outcome of both groups was compared. Out of 60 patients 30 patients underwent ACL reconstruction using Titanium screw and 30 patients underwent ACL reconstruction using Bioabsorbable screw. All patients were followed up for a period of 6 months post operatively. Improvement in patient condition was measured in terms of improved Knee range of motion, walking with or without support, any instability, any locking of knee, any pain while activity. Results: Mean preoperative Lysholm score for Titanium group was 52.60 and postoperative score is 85.56. Mean preoperative Lysholm score for Bioabsorbable Group is 54.70 mean postoperative score for group is 87.63. The increase in both scores was statistically significant when compared within the groups. And when both groups are compared, there was no significant difference between 2 groups. Few of our patients presented with anterior knee pain in immediate post-operative period which subsided with physiotherapy and medication, none of them had chronic knee pain. Conclusion: Our study shows that there is no difference in functional outcome whether bioabsorbable or titanium interference screw was used.

Loop changes after knee flexion-extension movement in a cadaveric anterior cruciate reconstruction model.

BackgroundRecently, adjustable-loop devices (ALDs) have been widely used, and their reliability has always been the focus of attention. This study compared loop length changes under pull stress caused by flexion and extension of the cadaver knee between ALDs and fixed-loop devices (FLDs) in terms of femoral fixation after anterior cruciate ligament (ACL) reconstruction.MethodsACL reconstruction in cadaveric knee joints was performed under arthroscopy with femoral suspension devices and tibial fixation by tying sutures on staples. The knee joint was repeatedly flexed and extended 30 times after fixation. According to the femoral fixation device used (Endobutton or Ultrabutton), the knee joints were divided into two groups: the ALD group (12 specimens) and the FLD group (ten specimens). The length of the loop before and after fixation was measured, and the loop length of the ALD group was re-measured 1 day after reconstruction.ResultsThere was no significant difference in the length of the loop between the two groups (t = 0.579, P = 0.569). One day later, the loop length of the ALDs retracted by 0.29 ± 0.33 (0–1.1) mm, and there was no retraction in three specimens.ConclusionThere was no significant difference in the loop length under flexion and extension stress after ACL reconstruction between ALDs and FLDs.