Clinical Outcomes of Three Different Modes of Femoral Hamstring Graft Fixation in Anterior Cruciate Ligament Reconstruction

Abstract

Introduction. There are various methods of anterior cruciate ligament (ACL) reconstruction of which the two main choices in autograft reconstruction involve the use of the bone-patella tendon-bone or hamstring graft. Femoral fixation can be divided into three main types: cortical suspensory devices such as Endobutton (Smith & Nephew, Arthrex), interference screws, and femoral transfixation devices such as Transfix (Arthrex) and Rigidfix (Depuy-Mitek). The aim of this study was to compare the clinical outcome between Rigidfix, Transfix and Endobutton devices for soft tissue femoral fixation in primary ACL reconstruction using the autogenous hamstring graft. Methods. We conducted our study in 48 patients admitted to our clinic, University Traumatology Clinic, Clinical Center "Mother Teresa", Skopje for ACL reconstruction from September 2009 to May 2013. The patients with ACL reconstruction were assigned as Rigidfix group (n=28), the second patients to Transfix group (n=13) and the third to Endobutton group (n=7). MRI of the knee joint was done prior to surgery. A data sheet, containing demographic data, examination findings and Tegner & Lysholm score, was completed for each patient. Results. Tegner & Lysholm the average scores before surgery were 2.52 and 34.75 (p>0.05). Six month after arthroscopy, the average value of Tegner and Lysholm scores in patients with ACL reconstruction was 8.37 and 89.08. Comparison among them showed that the operative mode of Endobutton femoral fixation had the highest level of the Lysholm score. Conclusions. Endobutton (Tight rope-RT) yielded a better outcome compared to the other two modes of femoral fixation in terms of instant stability of the graft and the general results.

The diagnostic accuracy of clinical tests for anterior cruciate ligament tears are comparable but the Lachman test has been previously overestimated: a systematic review and meta-analysis

“…Only two studies [6, 8] were not considered at risk of bias (Table 3). One study was an RCT [6], seven studies had a prospective design [8, 42, 43, 49, 54, 72, 75] and 14 assessed patients retrospectively [9, 12, 18, 20, 22, 26, 33, 38, 39, 41, 44, 45, 57, 62]. Arthroscopy and/or arthrotomy was used as a gold standard in 17 studies [6, 8, 9, 11, 12, 18, 20, 22, 25, 38, 39, 43, 44, 54, 57, 62, 72] with MRI reported as a reference standard in seven studies [26, 38, 41, 42, 45, 49, 75].…”

“…Isolated ACL tears were analysed in seven studies [6, 9, 11, 20, 25, 42, 49], whereas ten studies recruited patients with an isolated ACL tear or combined ACL tear and meniscal injury [8, 18, 20, 22, 26, 39, 41, 62, 72, 75]. The spectrum of conditions was not specified or unclear in eight studies [12, 18, 33, 38, 43–45, 57]. Patient cohorts with complete ACL tears only were analysed by ten studies [6, 8, 11, 12, 20, 25, 39, 42, 44, 75], partial ACL tears only were analysed in two studies [22, 42], combined complete and partial ACL tears in nine studies [9, 18, 22, 26, 38, 43, 45, 49, 75].…”

“…The spectrum of conditions was not specified or unclear in eight studies [12, 18, 33, 38, 43–45, 57]. Patient cohorts with complete ACL tears only were analysed by ten studies [6, 8, 11, 12, 20, 25, 39, 42, 44, 75], partial ACL tears only were analysed in two studies [22, 42], combined complete and partial ACL tears in nine studies [9, 18, 22, 26, 38, 43, 45, 49, 75]. Six studies did not specify the type of ACL tear [33, 41, 54, 57, 62, 72].…”

“…The average age of patients ranged from 21 [8] to 45 [6, 39] with seven studies including patients below 16 years of age [8, 9, 20, 33, 45, 49, 62]. Time from injury was not defined in three studies [38, 45, 72] while acute, subacute and/or chronic injuries were included in the same cohort in six studies [9, 33, 41, 43, 57, 75]; three studies described patients as acute yet did not specify time from injury [8, 49] or provided only the average time [62]. Each study has been screened for risk of bias based on 4 criteria of patient selection, index test, reference standard and flow and timing.…”

“…Bivariate random effects model meta‐analysis was possible for data from 12 studies (Table 4 and Supplemental Tables 4, 5, 6) [6, 11, 25, 26, 33, 38, 41, 45, 49, 54, 72, 75]. For all studies combined, the pivot shift test had the highest specificity (94%) and LR + (10.70), producing a large shift in the positive post‐test probability.…”