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, 26 (2), 94-97

TECHNICAL VARIATION IN AFFIXING HAMSTRING GRAFTS TO THE TIBIA IN ACL RECONSTRUCTION

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TECHNICAL VARIATION IN AFFIXING HAMSTRING GRAFTS TO THE TIBIA IN ACL RECONSTRUCTION

Marcus Vinicius Danieli et al. Acta Ortop Bras.

Abstract

Purpose: To present a technical variation in tibial fixation of quadruple hamstring grafts during anatomic reconstruction of the anterior cruciate ligament (ACL). The secondary purpose was to decrease the costs associated with this procedure.

Methods: Twenty patients who underwent ACL reconstruction were selected. A tibial tunnel was constructed using standard techniques, and a femoral tunnel was anatomically created using the outside-in technique. The hamstring autograft was passed (with its bend) into the tibial tunnel and affixed to the tibia using the suspensory technique and a simple staple. Femoral fixation was performed using a titanium interference screw. The patients underwent postoperative evaluations at 0, 3, 6 and 12 months using the subjective International Knee Documentation Committee (IKDC) form and Lysholm knee scores.

Results: The IKDC and Lysholm score results improved over time (p<0.001) without major complications. The cost of the procedure could be reduced by using lower-cost hardware (staples).

Conclusion: The proposed technique for anatomic ACL reconstruction using inverted hamstring grafts with their bend in the tibial tunnel, suspension-type fixation using a staple demonstrated good to excellent results after 1 year of follow up, with lower aggregate costs. Level of Evidence IV; Case series.

Keywords: Anterior cruciate ligament reconstruction; Orthopedic fixation devices.; Tendons.

Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. Tibial guide for the ACL, placed through the anterolateral portal to create the outside-in anatomic femoral tunnel (A). Intra-articular view (B). Right knee.
Figure 2
Figure 2. Femoral guide wire placed using the outside-in technique (A). Femoral and tibial tunnels - arthroscopic view (B). Left knee.
Figure 3
Figure 3. Postoperative X-rays: (A) AP and (B) lateral views showing tibial fixation with staple (right knee).
Figure 4
Figure 4. Illustration showing tibial fixation of the graft with a staple (inverted graft and suspension technique) in a right knee. Graft traction (*) and reduction of anterior draw (**).

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References

    1. Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient A prospective outcome study. Am J Sports Med. 1994;22(5):632–644. - PubMed
    1. Linko E, Harilainen A, Malmivaara A, Seitsalo S. Surgical versus conservative interventions for anterior cruciate ligament ruptures in adults. Cochrane Database Syst Rev. 2005;(2):CD001356–CD001356. - PubMed
    1. Owings MF, Kozak LJ. Ambulatory and inpatient procedures in the United States,1996. Vital Health Stat 13. 1998;(139):1–119. - PubMed
    1. Freedman KB, D&apos;Amato MJ, Nedeff DD, Kaz A, Bach BR., Jr Arthroscopic anterior cruciate ligament reconstruction a metaanalysis comparing patelar tendon and hamstring tendon autografts. Am J Sports Med. 2003;31(1):2–11. - PubMed
    1. Cournapeau J, Klouche S, Hardy P. Material costs of anterior cruciate ligament reconstruction with hamstring tendons by two different techniques. Orthop Traumatol Surg Res. 2013;99(2):196–201. - PubMed

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