ACL reconstruction with adjustable-length loop cortical button fixation results in less tibial tunnel widening compared with interference screw fixation

Abstract

Purpose To compare tunnel widening and clinical outcome after anterior cruciate ligament reconstruction (ACLR) with interference screw fixation and all‐inside reconstruction using button fixation. Methods Tunnel widening was assessed using tunnel volume and diameter measurements on computed tomography (CT) scans after surgery and 6 months and 2 years later, and compared between the two groups. The clinical outcome was assessed after 2 years with instrumented tibial anteroposterior translation measurements, hop testing and International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores. Results The study population at the final follow‐up was 14 patients with screw fixation and 16 patients with button fixation. Tibial tunnels with screw fixation showed significantly larger increase in tunnel volume over time (P = 0.021) and larger tunnel diameters after 2 years in comparison with button fixation (P < 0.001). There were no significant differences in femoral tunnel volume changes over time or in tunnel diameters after 2 years. No significant differences were found in the clinical outcome scores. Conclusions All‐inside ACLR using button fixation was associated with less tibial tunnel widening and smaller tunnels after 2 years in comparison with ACLR using screw fixation. The need for staged revision ACLRs may be greater with interference screws in comparison with button fixation at the tibial tunnel. The clinical outcomes in the two groups were comparable. Level of evidence II. RCT: Consort NCT01755819.

Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis

“…The in ammatory response or foreign body reaction to the bioabsorbable screw could be the biological cause for tunnel widening. Using advanced imaging, the current studies have shown signi cant increases in tunnel volume in the group of patients with bioabsorbable interference screws or even cyst formation at follow-up (13,17). Although the current evidence could not prove a correlation between tunnel widening and poor clinical outcomes or graft failure, the concern is that bone loss of the tunnel might be an obstacle for revision surgery, given the graft failure rate in young athletes was high (26).…”

“…Lubowitz et al had found no between-group difference in tunnel diameter as measured with plain lm radiography. In Mayr's study (9), with computed tomography as a main tool for measurement, a signi cant femoral tunnel volume increase was noted in the all-inside group at 6 months' follow-up; however, in the other study with longer follow-up times (24 months) for the same groups of patients, signi cantly increased tibia volumes and diameters were found in the full tibial tunnel group (17). Studies by Monaco et al and Colombet et al had found signi cant tibia tunnel widening in the group with interference screw xation.…”

“…In autologous graft selection, six studies (3,14,(16)(17)(18)(19) used quadrupled semitendinosus tendon (ST4) in the all-inside group and double gracilis and semitendinosus tendon (DGST) in the full tibial tunnel group; one study did not clearly mention the autologous tendon graft donor site (15). All the studies mentioned the suspensory cortical button graft xation device was used on both the femoral and tibial side in the allinside group of patients.…”

“…Two studies investigated the anteroposterior knee stability of the operative knee using the KT-1000 arthrometer (MedMetric Corporation, San Diego, CA, USA) (17,18), and one study (14) used the Rolimeter (Aircast, Europe). All the studies stated that knee stability improved signi cantly postoperatively, but no signi cant difference between groups was noted.…”

“…The phenomenon of drill tunnel widening had been investigated by several studies (9,12,13,17,18) and was considered to be associated with not only the method of tunnel prepared but also by the graft xation device. Thus, we included two more comparative studies investigating the difference between tunnel widening by suspensory cortical button xation and by interference screws (12,13).…”