Anterior Cruciate Ligament Graft Fixation—A Myth Busted?

Järvinen, Teppo L. N.; Alami, Ghassan B.; Karlsson, Jón

doi:10.1016/j.arthro.2009.11.023

Cited by 8 publications

(4 citation statements)

References 29 publications

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“…But the question remains, is graft slippage due to inadequate tibial fixation a real clinical concern? Jarvinen et al 19 published a very thoughtful opinion piece arguing that concerns about fixation strength in ACL reconstruction are a popular myth. They argued that there are only sparse case reports of early complete failure of reconstruction due to inadequate fixation; in addition, they took issue with the commonly cited estimate of loads applied to the ACL during normal activity (445 N) 36 stating that it is not clinically validated and that it is based on questionable assumptions.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Tibia Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Hybrid Tibia Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction

et al. 2016

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“…13 In addition, peak loads obtained with the revision screws are well above loads on the ACL measured in post-op patients during activities of daily living in multiple in vivo loading studies, lending further evidence that the revision construct provides adequate fixation. [14][15][16] However, the data in our model also suggest that in a revision scenario, yield load outcomes are more dependent on bone density than they are in a primary reconstruction. Namely, a moderate positive correlation with bone density and failure load in the revision construct (R 2 ¼ 0.43 up from 0.02 in the initial reconstruction) suggests that bone quality is more important in the revision repair in our model.…”

Section: Discussionmentioning

confidence: 66%

Mechanical Properties of Revision ACL Reconstruction

et al. 2013

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The aim of this study is to evaluate the mechanical properties of a revision anterior cruciate ligament (ACL) reconstruction after redrilling the original tibial bone tunnel through a retained composite screw compared with initial soft tissue graft fixation. A total of 24 porcine tendons were fixed to porcine tibial tunnels with a 10 × 35 mm composite interference screw. Following the pullout test, a revision tunnel was drilled through the first interference screw and a second graft was fixed in the bone tunnel using a larger composite screw (11 × 35 mm). Following insertion of the revision screw, the graft was reloaded as described for the primary reconstruction. Load versus displacement data were recorded for each test. There were no significant differences between the primary and revision reconstruction constructs for yield load (p = 0.62), linear stiffness (p = 0.18), maximum failure load (p = 0.57), and yield displacement (p = 0.46). These results indicate that the mechanical properties of tibial fixation for ACL reconstruction with a composite screw following a revision provide similar fixation compared with initial reconstruction in this model. Revising a failed composite ACL construct by means of overdrilling and reinstrumenting may provide fixation equivalent to the initial reconstruction.

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Section: Introductionmentioning

confidence: 99%

“…Graft fixation during anterior cruciate ligament reconstruction (ACLR) is a hotly debated topic [ 1 , 2 ]. Since the study by Kurosaka et al[ 3 ] in 1987, several hundred studies based mainly on in vitro biomechanical experiments have been devoted to this subject [ 1 ]. Given the lack of clinical studies demonstrating the superiority of one method over another, no gold standard has been recommended to date.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition in ACL reconstruction

Guy

Carrozzo

Ferreira

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to determine whether direct arthroscopic control of femoral buttons can prevent improper deployment and soft tissue interposition in anterior cruciate ligament (ACL) reconstruction. Methods A retrospective analysis of prospectively collected data from the SANTI study group database was performed. All patients who underwent ACL reconstruction using suspensive femoral fixation between 01/01/2017 and 31/12/2019 were included. Patient assessment included demographics, sports metrics, reoperations performed and femoral button-related specific complications such as iliotibial band (ITB) irritation and/or septic arthritis. Proper deployment of the button and soft tissue interposition were assessed on postoperative radiographs. Results A total of 307 patients underwent ACL reconstruction using adjustable femoral button fixation and were analyzed after a mean follow-up of 35.2 ± 11.0 months (14.3–50.2). The mean age was 39.5 ± 10.9-years old (range 13.3–70.6). Postoperative radiographs showed a correctly deployed femoral button without soft tissue interposition for all patients. No septic arthritis was reported. Nine patients (2.9%) suffered from lateral pain related to ITB irritation due to the button. Five of them had their symptoms resolve during rehabilitation. Ultrasound-guided corticosteroid infiltration was necessary for four patients after an average delay of 14.5 ± 4.8 months (11.7–21.7). Three patients were then symptom-free, but one required surgical removal of the implant 27.5 months after the surgery. Regarding unrelated femoral button complications, 15 patients (4.9%) underwent secondary arthroscopic procedures, including meniscectomy (1.6%), surgery for cyclops syndrome (2.6%) and revision ACLR (0.7%). Conclusion Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition without specific complications. Level of evidence Level IV.

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Anterior Cruciate Ligament Graft Fixation—A Myth Busted?

Cited by 8 publications

References 29 publications

Hybrid Tibia Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction

Hybrid Tibia Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction

Mechanical Properties of Revision ACL Reconstruction

Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition in ACL reconstruction

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