Arthroscopic ACL Reconstruction in Press-Fit Technique

Abstract

Press-fit techniques for arthroscopic ACL replacement have been developed to avoid problems and complications related to the use of interference screws. Improper insertion of screws may reduce primary stability, injure the posterior femoral cortex, or displace hardware into the joint. Most techniques described use press-fit on either the femoral or tibial side. To avoid any supplemental fixation material an arthroscopic method was developed which achieves patellar tendon autograft fixation by press-fit on both sides. On the femoral side angling of the patellar bone block in relation to the direction of ligament tension increases pullout strength. On the tibial side the oversized bone block anchors with progressive strength in the cylindrical tibial tunnel creating an ideal environment for osseous integration. Concurrently, a stable fixation is achieved allowing early functional rehabilitation. However, fixation strength depends on bone quality and the arthroscopic procedure is demanding.

Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis

“…It takes approximately 6 weeks for autograft bone blocks used during press‐fit fixation to osteointegrate [3, 42]. Since this fixation method depends on bone quality, it is suggested that press‐fit should be performed on younger, healthier individuals [24]. Moreover, fixation strength is dependent on the size of the bone block in relation to the tunnel and the mechanical properties of the bone (i.e., bone quality) [24].…”

“…Since this fixation method depends on bone quality, it is suggested that press‐fit should be performed on younger, healthier individuals [24]. Moreover, fixation strength is dependent on the size of the bone block in relation to the tunnel and the mechanical properties of the bone (i.e., bone quality) [24]. When there is poor bone quality, it has been recommended that interference screw fixation is used [24].…”

“…that press-it should be performed on younger, healthier individuals [24]. Moreover, ixation strength is dependent on the size of the bone block in relation to the tunnel and the mechanical properties of the bone (i.e., bone quality) [24]. When there is poor bone quality, it has been recommended that interference screw ixation is used [24].…”

“…Moreover, fixation strength is dependent on the size of the bone block in relation to the tunnel and the mechanical properties of the bone (i.e., bone quality) [24]. When there is poor bone quality, it has been recommended that interference screw fixation is used [24]. In multiple biomechanical studies, it has been found that femoral press‐fit fixation has adequate primary stability with ultimate load to failure at least equal to that of interference screws, which can be attributed to the graft being press‐fit in an undersized bone tunnel [4, 10, 36].…”