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Archives of Orthopaedic and Trauma Surgery

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01-07-2014 | Arthroscopy and Sports Medicine

ACL reconstruction using bone–patella tendon–bone autograft: press-fit technique vs. interference screw fixation

Authors: M. M. Sarzaeem, F. Najafi, M. Razi, M. A. Najafi

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 7/2014

Abstract

Purpose

The gold standard in ACL reconstructions has been the bone–patellar tendon–bone autograft fixed with interference screws. This prospective, randomized clinical trial aimed to compare two methods of fixation for BPTB grafts: press-fit fixation vs. interference screw, over a 12-month follow-up interval.

Methods

158 patients with an average age of 29.8 years, between 2011 and 2012, were treated for torn ACL. 82 patients underwent reconstruction with BPTB autograft with a press fit fixation technique, and in 76 cases an interference screw was used. At the time of final follow-up, 71 patients in press-fit group and 65 patients in interference screw group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion, IKDC score and complications.

Results

At 12-month follow-up, 59 (83 %) and 55 (85 %) in press-fit and screw group, respectively had good-to-excellent IKDC score (p > 0.05). The mean laxity assessed using a KT-1000 arthrometer improved to 2.7 and 2.5 mm in press-fit and screw group, respectively. Regarding Lachman and pivot shift test, there was a statistically significant improvement in the integrity of the ACL in both the groups, but no significant differences was noted between groups. There were no significant differences in terms of femur circumference difference, effusion, knee range of motion, pain and complications.

Conclusions

The press-fit technique is an efficient procedure. Its outcome was comparable with the interference screw group. Furthermore it has unlimited bone-to-bone healing, no need for removal of hardware, ease for revision and cost effectiveness.

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Daniel D, Stone M, Dobson B, Fithian D, Rossman D, Kaufman K (1994) Fate of the ACL-injured patient. Am J Sports Med 22:632–644PubMedCrossRef

Risberg M, Mork M, Krogstad-Jenssen H, Holm I (2001) 2001 design and implementation of a neuromuscular training program following anterior cruciate ligament. J Orthop Sports Phys Ther 31(11):620–631PubMedCrossRef

Lynch MA, Henning CE (1988) Osteoarthritis in the ACL-deficient knee. In: Feagin JA (ed) Churchill Livingstone, New York pp 385–91

Ferretti A, Conteduca F, De Carli A, Fontana M (1991) Mariani PP. Osteoarthritis of the knee after ACL reconstruction. Int Orthop 15:367–371PubMed

Jorgensen U, Sonne-Holm S, Lauridsen F, Rosenklint A (1987) Long-term follow-up of meniscectomy in athletes. A prospective longitudinal study. J Bone Joint Surg Br 69:80–83PubMed

Irrgang J, Safran M, Fu F (1996) The Knee: ligamentous and meniscal injuries. In: Zachazewski J, Magee D, Quillen W (eds) Athletic injuries and rehabilitation. W B Saunders, Pennsylvania, pp 623–692

Drogset JO, Straume LG, Bjørkmo I, Myhr G (2011) A prospective randomized study of ACL-reconstructions using bone-patellar tendon-bone grafts fixed with bioabsorbable or metal interference screws. Knee Surg Sports Traumatol Arthrosc 19:753–759PubMedCentralPubMedCrossRef

Fox J, Nedeff D, Spindler K (2002) Anterior cruciate ligament reconstruction with patellar autograft tendon. Clin Orthop Relat Res 402:53–63PubMedCrossRef

Salmon LJ, Russell VJ, Refshauge K, Kader D, Connolly C, Linklater J, Pinczewski LA (2006) Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 34:721–732PubMedCrossRef

10.

Kurosaka M, Yoshiya S (1987) Andrisch JT: a biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 15:225–229PubMedCrossRef

11.

Boszotta H (1997) Arthroscopic anterior cruciate ligament reconstruction using a patellar tendon graft in press-fit technique: surgical technique and follow-up. Arthroscopy 13:332–339PubMedCrossRef

12.

Graf BK, Henry J, Rothenberg M, Vanderby R (1994) Anterior cruciate ligament reconstruction with patellar tendon: an ex vivo study of wear related damage and failure at the femoral tunnel. Am J Sports Med 22:131–135PubMedCrossRef

13.

Carson WG (1991) A new technique of harvesting patellar tendon autografts for anterior cruciate ligament reconstruction. Arthroscopy 4:368–374CrossRef

14.

Jackson DW, Cohn BT, Morrison DS (1990) A new technique for harvesting the patella tendon in patients undergoing anterior cruciate ligament reconstruction. Orthopedics 13:165–167PubMed

15.

Franco GM, Bach BR, Bush-Joseph CA (1994) Intraarticular placement of kurosaka interference screws. Arthroscopy 10:412–417PubMedCrossRef

16.

Jomha NM, Raso VJ, Leung P (1993) Effect of varying angles on the pullout strength of interference screw fixation. Arthroscopy 9:580–583PubMedCrossRef

17.

Ouweleen KM, McElroy JJ (1995) A unique complication following arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 11:225–228PubMedCrossRef

18.

Fanelli GC, Desai BM, Cummings PD, Hanks GA, Kalenak A (1994) Divergent alignment of the femoral interference screw in single incision endoscopic reconstruction of the anterior cruciate ligament. Contemp Orthop 28:21–25

19.

Felmet G (2010) Implant-free anterior cruciate ligament reconstruction with diamond instruments. A biological and anatomic method for every ligament transplantation. Unfallchirurg 113:621–628PubMedCrossRef

20.

Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G (2005) ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc 13:248–255PubMedCrossRef

21.

Musahl V (2003) Abramowitch SD, Gabriel MT, Debski RE, Hertel P, Fu FH, Woo S LY: tensile properties of an anterior cruciate ligament graft after bone–patellar tendon–bone press-fit fixation. Knee Surg Sports Traumatol Arthrosc 11:68–74PubMed

22.

Rupp S (1997) Krauss PW, Fritsch EW: fixation strength of a biodegradable interference screw and a press-fit technique in anterior cruciate ligament reconstruction with a BPTB-graft. Arthroscopy 13:61–65PubMedCrossRef

23.

Pavlik A, Hidas P, Czigány T, Berkes I (2004) Biomechanical evaluation of press-fit femoral fixation technique in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 12:528–533PubMedCrossRef

24.

Lao ML, Chen JH, Wang CJ, Siu KK (2013) Functional Outcomes of Y-Graft Double-bundle and single-bundle anterior cruciate ligament reconstruction of the knee. Arthroscopy 29(9):1525–1535PubMedCrossRef

25.

Sutherland AG, Cooper K, Alexander LA, Nicol M, Smith FW, Scotland TR (2010) The long-term functional and radiological outcome after open reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 92:1096–1099PubMedCrossRef

26.

Shelbourne KD, Trumper RV (1997) Preventing anterior knee pain after anterior cruciate ligament reconstruction. Am J Sports Med 25:41–47PubMedCrossRef

27.

Jomha NM, Pinczewski LA, Clingeleffer A, Otto DD (1999) Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation: results at seven years. J Bone Joint Surg Br 81:775–779PubMedCrossRef

28.

Jarvela T, Paakkala T, Kannus P, Jarvinen M (2001) The incidence of patellofemoral osteoarthritis and associated findings 7 years after anterior cruciate ligament reconstruction with bone–patellar tendon–bone autograft. Am J Sports Med 29:18–24PubMed

29.

Widuchowski W, Widuchowska M, Koczy B, Dragan S, Czamara A, Tomaszewski W, Widuchowski J (2012) Femoral press-fit fixation in ACL reconstruction using bone–patellar tendon–bone autograft: results at 15 years follow-up. BMC Musculoskelet Disord 27(13):115CrossRef

30.

Harner CD, Fu FH, Irrgang JJ, Vogrin TM (2001) Anterior and posterior cruciate ligament reconstruction in the new millennium: a global perspective. Knee Surg Sports Traumatol Arthrosc 9:330–336PubMedCrossRef

31.

Aglietti P, Buzzi R, Giron F (1997) Simeone AJ, Zaccherotti G: arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon. A 5–8 year follow-up. Knee Surg Sports Traumatol Arthrosc 5:138–144PubMedCrossRef

32.

Jarvela T, Kannus P, Jarvinen M (2001) Anterior cruciate ligament reconstruction in patients with or without accompanying injuries: a re-examination of subjects 5–9 years after reconstruction. Arthroscopy 17:818–825PubMedCrossRef

33.

Pavlik A, Hidas P, Tallay A, Tomann J, Berkes I (2006) Femoral press-fit fixation technique in anterior cruciate ligament reconstruction using bone–patellar tendon–bone graft: a prospective clinical evaluation of 285 patients. Am J Sports Med 34:220PubMedCrossRef

34.

Pinczewski LA, Deehan DJ, Salmon LJ, Russel VJ, ClingeleVer A (2002) A five-year comparison of patellar tendon versus fourstrand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536PubMed

35.

Shelbourne KD, Gray T (1991) Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation. A two- to nine-year follow-up. Am J Sports Med 25:786–795CrossRef

36.

Taylor DC, Posner M, Curl WW, Feagin JA (2009) Isolated tears of the anterior cruciate ligament: over 30-year follow-up of patients treated with arthrotomy and primary repair. Am J Sports Med 37:65–71PubMedCrossRef

37.

Shelbourne KD, Gray T (2009) Minimum 10-year results after anterior cruciate ligament reconstruction: how the loss of normal knee motion compounds other factors related to the development of osteoarthritis after surgery. Am J Sports Med 37:471–480PubMedCrossRef

38.

Bonatus T, Alexander A (1991) Patellar fracture and avulsion of the patellar ligament complicating arthroscopic anterior cruciate ligament reconstruction. Orthop Rev 20:770–774PubMed

39.

Viola R, Vianello R (1999) Three cases of patella fracture in 1320 anterior cruciate ligament reconstructions with bone-patellar tendon–bone autograft. Arthroscopy 15:93–97PubMedCrossRef

40.

Felmet G (2010) Implant-free press-fit fixation for bone–patellar tendon–bone ACL reconstruction: 10-year results. Arch Orthop Trauma Surg 130:985–992PubMedCrossRef

41.

Ishibashi Y, Rudy TW, Livesay GA, Stone JD, Fu FH (1997) The effect of anterior cruciate ligament fixation site at the tibia on knee stability. Evaluation using a robotic testing system. Arthroscopy 13(2):177–182PubMedCrossRef

42.

Boszotta H (2003) Arthroscopic reconstruction of anterior cruciate ligament using BTB patellar ligament in the press-fit technique. Surg Technol Int 11:249–253PubMed

43.

Al-Husseiny M, Batterjee K (2004) Press-fit fixation in reconstruction of anterior cruciate ligament, using bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc 12:104–109PubMedCrossRef

Title: ACL reconstruction using bone–patella tendon–bone autograft: press-fit technique vs. interference screw fixation
Authors: M. M. Sarzaeem
F. Najafi
M. Razi
M. A. Najafi
Publication date: 01-07-2014
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 7/2014
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-014-1999-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

ACL reconstruction using bone–patella tendon–bone autograft: press-fit technique vs. interference screw fixation

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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