TightRope Versus Biocomposite Interference Screw for Fixation in Allograft ACL Reconstruction: Prospective Evaluation of Osseous Integration and Patient Outcomes

JB JS Open Access. 2020 Apr 2;5(2):e0057. doi: 10.2106/JBJS.OA.19.00057. eCollection 2020 Apr-Jun.


Background: Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure with many options regarding graft choice and graft fixation. The purpose of this study was to compare suspensory and aperture fixation in terms of femoral osseous integration of the bone block after ACL reconstruction with an Achilles tendon allograft.

Methods: After institutional review board approval and patient consent were obtained, 37 patients underwent ACL reconstruction with an Achilles tendon allograft. The patients were randomized according to the graft femoral fixation technique, which was with either a suspensory device (Arthrex TightRope) or aperture fixation by a biocomposite interference screw (Arthrex BioComposite Interference Screw or DePuy Mitek MILAGRO Interference Screw). Tibial fixation, performed with a biocomposite screw and knotless anchor, was identical in all patients. All patients underwent a computed tomography (CT) scan at 6 months to evaluate bone block incorporation of the femoral graft within the femoral tunnel, which was the study's primary outcome. Secondary outcome measures included a postoperative visual analogue scale (VAS) pain score, range-of-motion measures, and International Knee Documentation Committee scores. Demographic data were collected.

Results: Thirty-three patients (89%) completed the study's 6-month follow-up, at which time the femoral ossification score was significantly greater in the aperture fixation group (p = 0.025). There was no substantial difference between the 2 groups with regard to any other outcome measure.

Conclusions: Performing Achilles tendon allograft ACL reconstruction with femoral aperture fixation results in greater femoral bone block incorporation at 6 months postoperatively compared with what is seen after suspensory fixation.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.