Alternate Method of Arthroscopically Confirming Femoral Button Deployment for Knee Anterior Cruciate Ligament Graft Suspensory Cortical Fixation

Perumal, Rajamani; Gunasekaran, Chandrasekaran; Jacob, M; Jepegnanam, Thilak Samuel

doi:10.1016/j.eats.2018.08.019

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…Perumal et al modified this technique with the knee in full extension in order to relax the lateral soft tissue and obtain better visualization of the lateral gutter [8]. In our experience, we found advantages in performing button exploration with the knee in full extension allowing better visualization of the button deployment and better removal of the soft tissue around the button.…”

Section: Discussionmentioning

confidence: 65%

“…However, there is a radiation exposition for the patients, increased time in the operating room, and risk of field contamination if performed intra-operatively. Arthroscopic exploration of the lateral gutter to ensure femoral button deployment is recently described with the aim to reduce soft tissue interposition and reduce the need for radiographic control [7][8][9][10][11]. Although the surgical technique has been reported by many authors, the real benefits of this procedure has not been well demonstrated.…”

Section: Introductionmentioning

confidence: 99%

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Arthroscopic confirmation of femoral button deployment avoids post-operative X-ray in ACL reconstruction

Matassi

Sani

Innocenti

et al. 2020

The Physician and Sportsmedicine

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Background: Anterior cruciate ligament reconstruction (ACLR) with cortical fixation adjustable-loop devices are associated with high potential risk of button malpositioning or interposition of the soft tissue between lateral femoral cortex and the button. Surgeons usually use X-rays to check and avoid button malposition and soft tissue interposition. Arthroscopic visualization of button position through the lateral gutter has been described. With this technique, it is possible for identification and correction of femoral button malalignment in the setting of soft tissue interposition and it could avoid the use of post-operative X-ray. Methods: A total of 193 ACLR were included and patients were randomized into two groups. The first series (Group A) of 112 patients who sustained an ACLR with post-operative X-ray to assess the position of the femoral button and the second series (Group B) of 81 patients who sustained an ACLR with an arthroscopic exploration of the button followed by post-operative X-ray. Results: On the post-operative radiographs, tissue interposition between the button and femoral cortex was found in nine cases of 112 in Group A (8%) and in zero case of 81 in Group B (0%). In six cases (7,4%) in Group B, there was a soft tissue interposition between the button and femoral cortex as visualized by arthroscopic confirmation and before post-operative X-ray; in all these cases, the soft tissue was removed, and the button was in contact with the bone in all X-ray made in the Group B. Conclusions: This technique allows for identification and correction of femoral button malalignment in the setting of soft tissue interposition and reduces the use of post-operative X-ray.

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Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Arthroscopic confirmation of femoral button deployment avoids post-operative X-ray in ACL reconstruction

Matassi

Sani

Innocenti

et al. 2020

The Physician and Sportsmedicine

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“… 10 Arthroscopic direct visualization of the button deployment is a more effective method. Several studies have reported that the proper position was achieved through an arthroscopic view of the lateral gutter of the knee or an iliotibial band portal 4 , 8 , 11 , 16 in ACLR. It was reported that the femoral button placed with direct visualization was more likely to have an optimal position directly on the femoral cortex compared with indirect methods (0% vs 8.8%; P = .046).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Femoral Cortical Button Malposition in Posterior Cruciate Ligament Reconstruction

Zeng

Xie

Wang

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Femoral cortical button suspension fixation is a popular and reliable technique for posterior cruciate ligament reconstruction (PCLR). Button malposition during graft fixation can lead to postoperative graft loosening. Purpose: To determine the risk factors of femoral cortical button malposition in PCLR when neither direct visualization nor intraoperative fluoroscopy is used. Study Design: Case-control study; Level of evidence, 3. Methods: Of the 206 consecutive patients who underwent PCLR without direct visualization or intraoperative radiographs in 2019 at a single institution, 182 met the selection criteria and were included in the study. The distance from the suspension button to the femoral cortex was measured on postoperative computed tomography scans. The button was considered malpositioned if its distance to the femoral cortex was ≥2 mm. We evaluated patient-related and surgery-related variables, including age, sex, concomitant ligament reconstruction, button type, and surgeon experience. Multivariate logistic regression was conducted to evaluate the risk factors for button malposition. Results: The overall prevalence of button malposition was approximately 17.0% (31/182), and the mean distance from the button to the femoral cortex was 6.11 ± 5.82 mm in the malposition group. Male sex was the most significant risk factor for button malposition (odds ratio [OR], 13.86; 95% confidence interval [CI], 1.73-111.17; P = .013). Other independent risk factors were low surgical volume (completing ≤3 procedures; OR, 6.41; 95% CI, 1.89-21.72; P = .003), concomitant ligament reconstruction (OR, 5.56; 95% CI, 2.12-14.58; P < .001), and fixed-loop button (OR, 3.96; 95% CI, 1.11-14.18; P = .034). Conclusion: Male sex, low surgical volume, concomitant ligament reconstruction, and fixed-loop button were independent risk factors for femoral cortical button malposition during PCLR.

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“…Direct arthroscopic visualization, marking the femoral tunnel length on the graft, intraoperative fluoroscopy, and direct visualization of the button through a direct lateral incision have all been described. 2 , 8 - 10 , 12 Direct arthroscopic visualization is achieved by insertion of the arthroscope through the anteromedial portal, facilitating an unobstructed view of the femoral tunnel as the button is pulled through and out the smaller cortical hole, and by visualization of the button as it exits the tunnel to then be flipped horizontally. Balldin et al 1 described the use of intraoperative fluoroscopy to verify that the button is seated against the lateral femoral cortex.…”

mentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Button Fixation: A Case Series of Intraoperative Malpositioning

Arthur,

Zale,

Zhou

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Malpositioning of the femoral button is a known technical complication after anterior cruciate ligament (ACL) reconstruction with cortical suspensory fixation. The incidence of malpositioning, as well as the efficacy of methods to prevent malpositioning of cortical suspensory fixation devices, has not been reported. Purpose: To determine the rate of malpositioned cortical suspensory fixation devices after ACL reconstruction, investigate which intraoperative technique yields the lowest rate of malpositioning, and determine the return-to-duty rate for active-duty service members with malpositioned buttons and the revision rate for malpositioned buttons. Study Design: Case series; Level of evidence, 4. Methods: The records of patients who underwent primary ACL reconstruction with a cortical suspensory fixation device between 2008 and 2018 were reviewed at our institution. Postoperative radiographs were reviewed for evidence of malpositioned femoral buttons. Malpositioned buttons were classified as (1) fully positioned in the bone tunnel, (2) partially positioned in the bone tunnel, (3) >2 mm from cortical bone, or (4) deployed over the iliotibial band. Operative reports were reviewed to determine the intraoperative methods undertaken to verify the button position. The rate of malpositioned cases with subjective instability and revision surgery performed were determined. The ability of patients to return to full military duty was reviewed for active-duty personnel. Results: A total of 1214 patients met the inclusion criteria. A 3.5% rate (42 cases) of malpositioned cortical suspensory fixation devices (femoral buttons) was identified. For patients with malpositioned buttons, 7 (16.7%) patients underwent revision surgery in the immediate postoperative period. Techniques used to avoid malpositioning included direct arthroscopic visualization, direct open visualization, intraoperative fluoroscopy, and first passing the button through the skin before positioning on the femoral cortex. There was a 4.6% malposition rate using direct arthroscopic visualization and a 5.1% malposition rate using passage of the button through the skin, while no malpositioning occurred with intraoperative fluoroscopy or direct open visualization ( P < .05). Overall, 12 (28.6%) patients with malpositioned buttons ultimately underwent revision surgery. Despite having been diagnosed with malpositioned buttons, 21 (63.6%) active-duty members were able to return to full duty. Conclusion: Malpositioning of femoral buttons during ACL reconstruction occurred in 3.5% of patients in this series. The techniques of intraoperative fluoroscopy and direct open visualization are encouraged to prevent malpositioning.

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Alternate Method of Arthroscopically Confirming Femoral Button Deployment for Knee Anterior Cruciate Ligament Graft Suspensory Cortical Fixation

Cited by 5 publications

References 9 publications

Arthroscopic confirmation of femoral button deployment avoids post-operative X-ray in ACL reconstruction

Arthroscopic confirmation of femoral button deployment avoids post-operative X-ray in ACL reconstruction

Risk Factors for Femoral Cortical Button Malposition in Posterior Cruciate Ligament Reconstruction

Anterior Cruciate Ligament Reconstruction Using Femoral Cortical Button Fixation: A Case Series of Intraoperative Malpositioning

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