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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 6/2021

01-06-2021 | KNEE

Interference screws are more likely to perform better than cortical button and cross-pin fixation for hamstring autograft in ACL reconstruction: a Bayesian network meta-analysis

Authors: Lei Yan, Jiao Jiao Li, Yuanyuan Zhu, Haifeng Liu, Ruxing Liu, Bin Zhao, Bin Wang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2021

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Abstract

Purpose

Anterior cruciate ligament (ACL) reconstruction is widely accepted as the first choice of treatment for ACL injury, but there is disagreement in the literature regarding the optimal femoral fixation method. This meta-analysis assesses the evidence surrounding three common femoral fixation methods: cortical button (CB), cross-pin (CP) and interference screws (IS).

Methods

A systematic search was conducted in Medline, EMBASE and the Cochrane Library to identify studies with evidence level I or II that compared at least two femoral fixation methods with hamstring autograft for ACL reconstruction. Ten primary outcomes were collected. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMD) were estimated using random-effects network meta-analysis in a Bayesian framework. Probability of ranking best (ProBest) and surface under the cumulative ranking curve (SUCRA) were used to rank all treatments. Funnel plots were used to identify publication bias and small-study effects.

Results

Sixteen clinical trials were included for analysis out of 2536 retrieved studies. Bayesian network meta-analysis showed no significant differences among the three fixation methods for the ten primary outcome measures. Based on the 10 outcome measures, the IS, CB and CP had the highest ProBest in 5, 5 and 0 outcomes, and the highest SUCRA values in 5, 4 and 1 outcomes, respectively. No substantial inconsistency between direct and indirect evidence, or publication bias was detected in the outcomes.

Conclusion

There were no statistical differences in performance among the CP, CB and IS femoral fixation methods with hamstring autograft in ACL reconstruction, although the IS was more likely to perform better than CB and CP based on the analysis of outcome measures from the included studies.

Level of evidence

1.
Appendix
Available only for authorised users
Literature
1.
Ahmad CS, Gardner TR, Groh M, Arnouk J, Levine WN (2004) Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction. Am J Sports Med 32:635–640PubMed
2.
Basad E, Kipper A, Wüsten O, Stürz H, Ishaque B (2010) Vergleichende Studie nach vorderer Hamstring-Kreuzbandplastik mit RigidFix® (Pinfixation) und EndoButton® (Ankerfixation). Z Orthop Unfall 148:276–281PubMed
3.
Baumfeld JA, Diduch DR, Rubino LJ, Hart JA, Miller MD, Barr MS et al (2008) Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc 16:1108–1113PubMed
4.
Becker R, Voigt D, Starke C, Heymann M, Wilson GA, Nebelung W (2001) Biomechanical properties of quadruple tendon and patellar tendon femoral fixation techniques. Knee Surg Sports Traumatol Arthrosc 9:337–342PubMed
5.
Bjorkman P, Sandelin J, Harilainen A (2014) A randomized prospective controlled study with 5-year follow-up of cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23:2353–2359PubMed
6.
Browning WM 3rd, Kluczynski MA, Curatolo C, Marzo JM (2017) Suspensory versus aperture fixation of a quadrupled hamstring tendon autograft in anterior cruciate ligament reconstruction: a meta-analysis. Am J Sports Med 45:2418–2427PubMed
7.
Buelow JU, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85PubMed
8.
Cannas A, Goletti D, Girardi E, Chiacchio T, Calvo L, Cuzzi G et al (2008) Mycobacterium tuberculosis DNA detection in soluble fraction of urine from pulmonary tuberculosis patients. Int J Tuberc Lung Dis 12:146–151PubMed
9.
Capuano L, Hardy P, Longo UG, Denaro V, Maffulli N (2008) No difference in clinical results between femoral transfixation and bio-interference screw fixation in hamstring tendon ACL reconstruction. A preliminary study. Knee 15:174–179PubMed
10.
Clark R, Olsen RE, Larson BJ, Goble EM, Farrer RP (1998) Cross-pin femoral fixation: a new technique for hamstring anterior cruciate ligament reconstruction of the knee. Arthroscopy 14:258–267PubMed
11.
Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7:138–145PubMed
12.
Colvin A, Sharma C, Parides M, Glashow J (2011) What is the best femoral fixation of hamstring autografts in anterior cruciate ligament reconstruction?: a meta-analysis. Clin Orthop Relat Res 469:1075–1081PubMed
13.
Eajazi A, Madadi F, Madadi F, Boreiri M (2013) Comparison of different methods of femoral fixation anterior cruciate ligament reconstruction. Acta Med Iran 51:444–448PubMed
14.
Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21:1337–1341PubMed
15.
Feng J, Luo M, Ma J, Tian Y, Han X, Bai D (2019) The treatment modalities of masticatory muscle pain a network meta-analysis. Medicine (Baltimore) 98:e17934
16.
Gabr A, O’Leary S, Spalding T, Bollen S, Haddad F (2015) The UK National Ligament Registry Report 2015. Knee 22:351–353PubMed
17.
Giurea M, Zorilla P, Amis AA, Aichroth P (1999) Comparative pull-out and cyclic-loading strength tests of anchorage of hamstring tendon grafts in anterior cruciate ligament reconstruction. Am J Sports Med 27:621–625PubMed
18.
Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA (2016) Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 50:804–808PubMedPubMedCentral
19.
Guo L, Yang L, Duan XJ, He R, Chen GX, Wang FY et al (2012) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft: comparison of autograft, fresh-frozen allograft, and gamma-irradiated allograft. Arthroscopy 28:211–217PubMed
20.
Hammer DL, Brown CH, Steiner ME et al (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81:549
21.
Harilainen A, Sandelin J (2009) A prospective comparison of 3 hamstring acl fixation devices- Rigidfix, bioscrew, and intrafix- randomized into 4 groups with 2 years of follow-up. Am J Sports Med 37:699–706PubMed
22.
Harilainen A, Sandelin J, Jansson KA (2005) Cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons: results of a controlled prospective randomized study with 2-year follow-up. Arthroscopy 21:25–33PubMed
23.
Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928PubMedPubMedCentral
24.
Hogervorst T, Howard RA, Thornton GM, Paulson K, Shrive NG, Ronsky JL et al (2002) A potential animal model for creating a controlled and reversible anterior cruciate ligament insufficiency. Knee 9:209–214PubMed
25.
Hoher J, Livesay GA, Ma CB, Withrow JD, Fu FH, Woo SL (1999) Hamstring graft motion in the femoral bone tunnel when using titanium button/polyester tape fixation. Knee Surg Sports Traumatol Arthrosc 7:215–219PubMed
26.
Howell SM, Hull ML (1998) Aggressive rehabilitation using hamstring tendons: graft construct, tibial tunnel placement, fixation properties, and clinical outcome. Am J Knee Surg 11:120–127PubMed
27.
Hurley ET, Gianakos AL, Anil U, Strauss EJ, Gonzalez-Lomas G (2019) No difference in outcomes between femoral fixation methods with hamstring autograft in anterior cruciate ligament reconstruction—a network meta-analysis. Knee 26:292–301PubMed
28.
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C et al (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162:777–784PubMed
29.
Ibrahim SA, Abdul Ghafar S, Marwan Y, Mahgoub AM, Al Misfer A, Farouk H et al (2015) Intratunnel versus extratunnel autologous hamstring double-bundle graft for anterior cruciate ligament reconstruction: a comparison of 2 femoral fixation procedures. Am J Sports Med 43:161–168PubMed
30.
Ibrahim SA, Hamido F, Al Misfer AK, Mahgoob A, Ghafar SA, Alhran H (2009) Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures. Journal of bone and joint surgery. J Bone Joint Surg Br 91:1310–1315PubMed
31.
Ilahi OA, Nolla JM, Ho DM (2009) Intra-tunnel fixation versus extra-tunnel fixation of hamstring anterior cruciate ligament reconstruction: a meta-analysis. J Knee Surg 22:120–129PubMed
32.
Ishibashi Y, Rudy TW, Livesay GA, Stone JD, Fu FH, Woo SL (1997) The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. Arthroscopy 13:177–182PubMed
33.
Kousa P, Jarvinen TLN, Vihavainen M, Kannus P, Jarvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part II: tibial site. Am J Sports Med 31:182–188PubMed
34.
Kuskucu SM (2008) Comparison of short-term results of bone tunnel enlargement between EndoButton™ CL and cross-pin fixation systems after chronic anterior cruciate ligament reconstruction with autologous quadrupled hamstring tendons. J Int Med Res 36:23–30PubMed
35.
L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238PubMed
36.
Lehmann A-K, Osada N, Zantop T, Raschke MJ, Petersen W (2009) Femoral bridge stability in double-bundle ACL reconstruction: impact of bridge width and different fixation techniques on the structural properties of the graft/femur complex. Arch Orthop Trauma Surg 129:1127–1132PubMed
37.
Lind M, Menhert F, Pedersen AB (2009) The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5,818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 17:117–124PubMed
38.
Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH (2003) Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 20:
39.
Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH (2004) Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 20:122–128PubMed
40.
Magnussen RA, Granan LP, Dunn WR, Amendola A, Andrish JT, Brophy R et al (2010) Cross-cultural comparison of patients undergoing ACL reconstruction in the United States and Norway. Knee Surg Sports Traumatol Arthrosc 18:98–105PubMedPubMedCentral
41.
Mascarenhas R, Saltzman BM, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C et al (2015) Bioabsorbable versus metallic interference screws in anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses. Arthroscopy 31:561–568PubMed
42.
Milano G, Mulas PD, Ziranu F, Piras S, Manunta A, Fabbriciani C (2006) Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: a biomechanical analysis. Arthroscopy 22:660–668PubMed
43.
Nebelung W, Becker R, Merkel M, Ropke M (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side. Arthroscopy 14:810–815PubMed
44.
Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE (2012) Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sport Med 22:116–121PubMedPubMedCentral
45.
Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE (2014) Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med 42:1567–1573PubMedPubMedCentral
46.
Price R, Stoney J, Brown G (2010) Prospective randomized comparison of endobutton versus cross-pin femoral fixation in hamstring anterior cruciate ligament reconstruction with 2-year follow-up. ANZ J Surg 80:162–165PubMed
47.
Rose T, Hepp P, Venus J, Stockmar C, Josten C, Lill H (2006) Prospective randomized clinical comparison of femoral transfixation versus bioscrew fixation in hamstring tendon ACL reconstruction—a preliminary report. Knee Surg Sports Traumatol Arthrosc 14:730–738PubMed
48.
Salanti G, Ades AE, Ioannidis JPA (2011) Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol 64:163–171PubMed
49.
Shen XZ, Qu F, Li CB, Qi W, Lu X, Li HL et al (2018) Comparison between a novel human cortical bone screw and bioabsorbable interference screw for graft fixation of ACL reconstruction. Eur Rev Med Pharmacol Sci 22:111–118PubMed
50.
Sim JA, Kwak JH, Yang SH, Lee BK (2009) Comparative biomechanical study of the Ligament Plate (R) and other fixation devices in ACL reconstruction. Int Orthop 33:1269–1274PubMed
51.
Srinivas DK, Kanthila M, Saya RP, Vidyasagar J (2016) Femoral and tibial tunnel widening following anterior cruciate ligament reconstruction using various modalities of fixation: a prospective observational study. J Clin Diagn Res 10:09–11
52.
Stengel D, Casper D, Bauwens K, Ekkernkamp A, Wich M (2009) Bioresorbable pins and interference screws for fixation of hamstring tendon grafts in anterior cruciate ligament reconstruction surgery: a randomized controlled trial. Am J Sports Med 37:1692–1698PubMed
53.
To JT, Howell SM, Hull ML (1999) Contributions of femoral fixation methods to the stiffness of anterior cruciate ligament replacements at implantation. Arthroscopy 15:379–387PubMed
54.
Weimann A, Rodieck M, Zantop T, Hassenpflug J, Petersen W (2005) Primary stability of hamstring graft fixation with biodegradable suspension versus interference screws. Arthroscopy 21:266–274PubMed
Metadata
Title
Interference screws are more likely to perform better than cortical button and cross-pin fixation for hamstring autograft in ACL reconstruction: a Bayesian network meta-analysis
Authors
Lei Yan
Jiao Jiao Li
Yuanyuan Zhu
Haifeng Liu
Ruxing Liu
Bin Zhao
Bin Wang
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06231-x

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