Background: Tear of the anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. Reconstruction of this ligament is often required to restore functional stability of the knee. Outcome of ACL reconstruction is significantly affected by how the graft is fixed to the bone. This study is to determine if there is a different clinical outcome after cortical versus cortical-cancellous suspension femoral fixation in hamstring based anterior cruciate ligament (ACL) reconstruction.
Materials and methods: This is a retrospective comparative study conducted between 2006 and 2010. We enrolled patients who underwent arthroscopic ACL reconstruction. Sixty two patients met inclusion criteria and 41 agreed to come for followup assessment. Median age was of 28 years (range 18-39 years). Demographic baseline profile of both groups was similar. The femoral fixation devices were cortical (n = 16) and cortical-cancellous suspension techniques (n = 25). The average period of evolution at the time of assessment was 40 months (range 12-72 months). The patients were examined according to Lachman test (using Rolimeter knee tester), anterior drawer test, pivot shift test, International Knee Documentation Committee questionnaire, and Tegner-Lysholm knee scoring scale.
Results: The objective evaluation of the patients (Lachman test) showed better results in terms of stability in the group of patients who underwent the cortical-cancellous suspension method. These differences were not reflected in the assessment of activity level (Tegner-Lysholm), where both groups showed the same results.
Conclusions: ACL reconstruction with both cortical and cortical-cancellous suspension femoral fixation techniques show the same clinical results at medium long followup. However, cortical-cancellous fixations seem to provide greater stability to the reconstruction.
Keywords: Anterior cruciate ligament reconstruction; Arthroscopic surgical procedures; RetroButton; TransFix; anterior cruciate ligament; arthroscopy; cruciate ligament; femoral fixation device; knee.
Conflict of interest statement
There are no conflicts of interest.
Clinical and Radiological Outcomes After Hamstring Anterior Cruciate Ligament Reconstructions: Comparison Between Fixed-Loop and Adjustable-Loop Cortical Suspension DevicesNH Choi et al. Am J Sports Med 45 (4), 826-831. PMID 27881383.Compared with femoral fixation by use of the fixed-loop device, femoral fixation by use of the adjustable-loop device showed similar clinical outcomes but did not reduce …
Evaluation and Comparison of Clinical Results of Femoral Fixation Devices in Arthroscopic Anterior Cruciate Ligament ReconstructionD Aydin et al. Knee 23 (2), 227-32. PMID 25937093.In this study, the clinical results of different suspensory femoral fixation techniques were found to be similar. We believe that different femoral fixation techniques ha …
Effects of Pre-Operative Knee Laxity on Clinical Outcomes After Partial Anterior Cruciate Ligament ReconstructionB Li et al. Knee 25 (3), 445-452. PMID 29685502.In the patients with partial ACL rupture, the mechanical strength of the remnant ligament has significant influence on the therapeutic effects of partial reconstruction. …
Suspensory Versus Aperture Fixation of a Quadrupled Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysisWM Browning 3rd et al. Am J Sports Med 45 (10), 2418-2427. PMID 28068159. - ReviewThis meta-analysis demonstrated improved overall arthrometric stability and fewer graft ruptures using suspensory fixation compared with aperture fixation of a quadrupled …
A Meta-Analysis of Bone-Patellar Tendon-Bone Autograft Versus Four-Strand Hamstring Tendon Autograft for Anterior Cruciate Ligament ReconstructionX Xie et al. Knee 22 (2), 100-10. PMID 25547048. - ReviewBased on the results above, ACL reconstruction with BPTB autografts might be superior in resuming rotation stability of the knee joint and allow patients to return to hig …
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- Kim JG, Wang JH, Ahn JH, Kim HJ, Lim HC. Comparison off em oral tunnel length between transportal and retrograde reaming outside-in techniques in anterior cruciate ligament reconstruct. Knee Surg Sports Traumatol Arthrosc. 2013;21:830–8. - PubMed
- Iorio R, Di Sanzo V, Vadalà A, Conteduca J, Mazza D, Redler A, et al. ACL reconstruction with hamstrings: How different technique and fixation devices influence bone tunnel enlargement. Eur Rev Med Pharmacol Sci. 2013;17:2956–61. - PubMed
- Samuelsson K, Andersson D, Karlsson J. Treatment of anterior cruciate ligament injuries with special reference to graft type and surgical technique: An assessment of randomized controlled trials. Arthroscopy. 2009;25:1139–74. - PubMed
- Yasuda K, Kitamura N, Kondo E, Hayashi R, Inoue M. One-stage anatomic double- bundle anterior and posterior cruciate ligament reconstruction using the autogenous hamstring tendons. Knee Surg Sports Traumatol Arthrosc. 2009;17:800–5. - PubMed
- Ilahi OA, Nolla JM, Ho DM. Intratunnel fixation versus extratunnel fixation of hamstring anterior cruciate ligamento reconstruction: A meta-analysis. JKnee Surg. 2009;22:120–9. - PubMed