ACL Reconstruction with Adjustable-length Loop Cortical Button Fixation Results in Less Tibial Tunnel Widening Compared with Interference Screw Fixation

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2019 Aug 3

PMID 31372680

Citations 26

Authors

Raul Mayr

Vinzenz Smekal

Christian Koidl

Christian Coppola

Martin Eichinger

Ansgar Rudisch

Christof Kranewitter

Rene Attal

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare tunnel widening and clinical outcome after anterior cruciate ligament reconstruction (ACLR) with interference screw fixation and all-inside reconstruction using button fixation.

Methods: Tunnel widening was assessed using tunnel volume and diameter measurements on computed tomography (CT) scans after surgery and 6 months and 2 years later, and compared between the two groups. The clinical outcome was assessed after 2 years with instrumented tibial anteroposterior translation measurements, hop testing and International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores.

Results: The study population at the final follow-up was 14 patients with screw fixation and 16 patients with button fixation. Tibial tunnels with screw fixation showed significantly larger increase in tunnel volume over time (P = 0.021) and larger tunnel diameters after 2 years in comparison with button fixation (P < 0.001). There were no significant differences in femoral tunnel volume changes over time or in tunnel diameters after 2 years. No significant differences were found in the clinical outcome scores.

Conclusions: All-inside ACLR using button fixation was associated with less tibial tunnel widening and smaller tunnels after 2 years in comparison with ACLR using screw fixation. The need for staged revision ACLRs may be greater with interference screws in comparison with button fixation at the tibial tunnel. The clinical outcomes in the two groups were comparable.

Level Of Evidence: II. RCT: Consort NCT01755819.

Citing Articles

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References

Emond C, Woelber E, Kurd S, Ciccotti M, Cohen S . A comparison of the results of anterior cruciate ligament reconstruction using bioabsorbable versus metal interference screws: a meta-analysis. J Bone Joint Surg Am. 2011; 93(6):572-80. DOI: 10.2106/JBJS.J.00269. View

Monaco E, Fabbri M, Redler A, Gaj E, De Carli A, Argento G . Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation. Knee Surg Sports Traumatol Arthrosc. 2018; 27(8):2577-2584. DOI: 10.1007/s00167-018-5275-x. View

Rodeo S, Kawamura S, Kim H, Dynybil C, Ying L . Tendon healing in a bone tunnel differs at the tunnel entrance versus the tunnel exit: an effect of graft-tunnel motion?. Am J Sports Med. 2006; 34(11):1790-800. DOI: 10.1177/0363546506290059. View

Lubowitz J . All-inside anterior cruciate ligament graft link: graft preparation technique. Arthrosc Tech. 2013; 1(2):e165-8. PMC: 3678625. DOI: 10.1016/j.eats.2012.06.002. View

Bressy G, Brun V, Ferrier A, Dujardin D, Oubaya N, Morel N . Lack of stability at more than 12 months of follow-up after anterior cruciate ligament reconstruction using all-inside quadruple-stranded semitendinosus graft with adjustable cortical button fixation in both femoral and tibial sides. Orthop Traumatol Surg Res. 2016; 102(7):867-872. DOI: 10.1016/j.otsr.2016.08.011. View

Beynnon B, Johnson R, Fleming B, Kannus P, Kaplan M, Samani J . Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Joint Surg Am. 2002; 84(9):1503-13. DOI: 10.2106/00004623-200209000-00001. View

Branch T, Stinton S, Hutton W, Neyret P . The combination of tibial anterior translation and axial rotation into a single biomechanical factor improves the prediction of patient satisfaction over each factor alone in patients with ACL reconstructed knees. Knee Surg Sports Traumatol Arthrosc. 2017; 25(4):1038-1047. PMC: 5420376. DOI: 10.1007/s00167-017-4497-7. View

Connaughton A, Geeslin A, Uggen C . All-inside ACL reconstruction: How does it compare to standard ACL reconstruction techniques?. J Orthop. 2017; 14(2):241-246. PMC: 5360217. DOI: 10.1016/j.jor.2017.03.002. View

Mochizuki Y, Kaneko T, Kawahara K, Toyoda S, Kono N, Hada M . The quadrant method measuring four points is as a reliable and accurate as the quadrant method in the evaluation after anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2017; 26(8):2389-2394. DOI: 10.1007/s00167-017-4797-y. View

10.

Tiefenboeck T, Hirtler L, Winnisch M, Joestl J, Koch T, Komjati M . A bigger suture diameter for anterior cruciate ligament all-inside graft link preparation leads to better graft stability: An anatomical specimen study. Knee. 2018; 25(3):427-433. DOI: 10.1016/j.knee.2018.03.010. View

11.

Webster K, Feller J, Hameister K . Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2001; 9(2):86-91. DOI: 10.1007/s001670100191. View

12.

Inderhaug E, Strand T, Fischer-Bredenbeck C, Solheim E . Effect of a too posterior placement of the tibial tunnel on the outcome 10-12 years after anterior cruciate ligament reconstruction using the 70-degree tibial guide. Knee Surg Sports Traumatol Arthrosc. 2013; 22(5):1182-9. DOI: 10.1007/s00167-013-2593-x. View

13.

Boutsiadis A, Panisset J, Devitt B, Mauris F, Barthelemy R, Barth J . Anterior Laxity at 2 Years After Anterior Cruciate Ligament Reconstruction Is Comparable When Using Adjustable-Loop Suspensory Fixation and Interference Screw Fixation. Am J Sports Med. 2018; 46(10):2366-2375. DOI: 10.1177/0363546518784005. View

14.

Mayr R, Smekal V, Koidl C, Coppola C, Fritz J, Rudisch A . Tunnel widening after ACL reconstruction with aperture screw fixation or all-inside reconstruction with suspensory cortical button fixation: Volumetric measurements on CT and MRI scans. Knee. 2017; 24(5):1047-1054. DOI: 10.1016/j.knee.2017.06.007. View

15.

Lubowitz J, Schwartzberg R, Smith P . Cortical Suspensory Button Versus Aperture Interference Screw Fixation for Knee Anterior Cruciate Ligament Soft-Tissue Allograft: A Prospective, Randomized Controlled Trial. Arthroscopy. 2015; 31(9):1733-9. DOI: 10.1016/j.arthro.2015.03.006. View

16.

Pereira H, Pereira H, Correlo V, Silva-Correia J, Oliveira J, Reis R . Migration of "bioabsorbable" screws in ACL repair. How much do we know? A systematic review. Knee Surg Sports Traumatol Arthrosc. 2013; 21(4):986-94. DOI: 10.1007/s00167-013-2414-2. View

17.

Xu Y, Ao Y, Wang J, Yu J, Cui G . Relation of tunnel enlargement and tunnel placement after single-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2011; 27(7):923-32. DOI: 10.1016/j.arthro.2011.02.020. View

18.

Zantop T, Weimann A, Schmidtko R, Herbort M, Raschke M, Petersen W . Graft laceration and pullout strength of soft-tissue anterior cruciate ligament reconstruction: in vitro study comparing titanium, poly-d,l-lactide, and poly-d,l-lactide-tricalcium phosphate screws. Arthroscopy. 2006; 22(11):1204-10. DOI: 10.1016/j.arthro.2006.06.015. View

19.

Wilson T, Kantaras A, Atay A, Johnson D . Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med. 2004; 32(2):543-9. DOI: 10.1177/0363546504263151. View

20.

Marchant Jr M, Willimon S, Vinson E, Pietrobon R, Garrett W, Higgins L . Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2009; 18(8):1059-64. DOI: 10.1007/s00167-009-0952-4. View