Cortical Suspensory Fixation Research Articles

Extensive Heterotopic Ossification After Suspensory Cortical Fixation of Acute Distal Biceps Tendon Ruptures

Suspensory cortical fixation is commonly used for distal biceps tendon repair and reconstruction with one of several commercially available devices. The single-incision approach typically used with these devices is believed to have a lower incidence of heterotopic ossification than the dual-incision technique, but the true incidence of heterotopic ossification is unknown. The role of chemotherapeutic or radiation prophylaxis is undefined. We have identified 4 cases of extensive heterotopic ossification after biceps fixation with a suspensory button and single-incision approach. Surgeons should be aware of this potential complication when using suspensory cortical buttons for distal biceps fixation.

All-Inside Anterior Cruciate Ligament Graft-Link Technique: Second-Generation, No-Incision Anterior Cruciate Ligament Reconstruction

We describe an anatomic, single-bundle, all-inside anterior cruciate ligament (ACL) graft-link technique using second-generation Flipcutter guide pins (Arthrex, Naples, FL), which become retrograde drills, and second-generation cortical suspensory fixation devices with adjustable graft loop length: femoral TightRope (Arthrex) and tibial ACL TightRope–Reverse Tension (Arthrex). The technique is minimally invasive using only four 4-mm stab incisions. Graft choice is no-incision allograft or gracilis-sparing, posteriorly harvested semitendinosus material. The graft is sutured 4 times through each strand in a loop and linked, like a chain, to femoral and tibial adjustable TightRope graft loops. With this method, graft tension can be increased even after graft fixation. The technique may be modified for double-bundle ACL reconstruction.

Endobutton Femoral Fixation for Hamstring Anterior Cruciate Ligament Reconstruction: Surgical Technique and Results

Summary: The technique for endobutton femoral fixation of double semitendinosus/ double gracilis hamstring anterior cruciate ligament (ACL) reconstruction is described. Two- to 8-year follow up of 139 primary ACL reconstructions in skeletally mature patients found 86% IKDC normal stability and 97% 3 mm KT 1000 side-to-side stability rates. No knee had 5 mm or greater differences. There were no graft failures and no clinical knee instability. No endobutton lost position. There were no deep knee infections or hardware-related complications. Endobutton femoral fixation produced high levels of knee stability with no hardware-related complications. Key Words: ACL—Knee—Femoral fixation—Hamstring. In our metaanalysis of stability after anterior cruciate ligament (ACL) reconstruction, we found endobutton and interference screws to be the most commonly used femoral fixation devices among clinical series reported since 1990 that met our criteria for inclusion. The endobutton (Smith and Nephew, Andover, MA) is a cortical suspensory ACL fixation device. It is a 12-mm long oval button with a woven loop passed through its 2 central holes. A quadruple hamstring (HS), or any similar soft tissue, graft is passed through the loop and doubled back on itself. We began using it in 1993 and have used it continuously from then to the present. Its anchorage on cortical bone produces high stiffness, which is mitigated to a degree by the high length of the graft-fixation construct.10 Studies have shown it to have among the highest strength of any femoral fixation devices1 After a brief overview of the technique, we present clinical pearls that describe how to use the system to maximum advantage, how to avoid problems, and what to do if difficulties occur. We have found the system safe, reliable, and easy to use over a long period of time.