Femoral Cortical Suspension Devices for Soft Tissue Anterior Cruciate Ligament Reconstruction

Petre, Benjamin M.; Smith, Sean D.; Jansson, Kyle S.; Meijer, Peter-Paul de; Hackett, Thomas R.; LaPrade, Robert F.; Wijdicks, Coen A.

doi:10.1177/0363546512469875

Cited by 166 publications

(266 citation statements)

References 23 publications

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“…7 A recent biomechanical study has shown that the median ultimate failure load after coracoid fixation with 2 metal screws was 202 N (range, 95-300 N), 8 whereas another study has shown that the ultimate failure strength of the Arthrex knotless ACL TightRope-RT as a construct was 859 N, considerably higher than the strength required for a Latarjet procedure. 9 The dynamic sling effect of the conjoint tendon is considered important in the stabilizing effect of the Latarjet procedure.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation Device

Kalogrianitis

Tsouparopoulos

2016

Arthroscopy Techniques

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Recurrent anterior shoulder instability with significant bone loss represents a surgical challenge. Anterior bone block procedures including variations of the Latarjet coracoid transfer have been used in this setting. Bone graft resorption with prominence of the metalwork is a serious concern, whereas the relative contribution of the dynamic sling effect of a Latarjet procedure is still controversial. We describe an arthroscopic technique for anatomic reconstruction of anterior glenoid bone defects using autologous iliac crest graft. This technique allows accurate placement of the bone block; fixation with 2 knotless TightRope devices (Arthrex, Naples, FL), avoiding the use of screws; and a final labral repair. R ecurrent anterior shoulder instability is associated with bone loss in 90% of cases. With significant bone loss, primary arthroscopic Bankart repair carries a high risk of failure in more than 70% of cases. Although not clearly defined yet, biomechanical studies suggest that critical glenoid bone loss is around 20%. Most of the defects, though, are bipolar lesions and can be managed with glenoid-based surgery. On the glenoid side, the workhorse has been the Latarjet procedure and its variations. Other options include the use of tricortical iliac crest graft or distal tibial allograft. The arthroscopic Latarjet procedure has been gaining increasing popularity recently, whereas only a few arthroscopic techniques have been described for iliac crest bone graft. 1,2We describe an arthroscopic technique for reconstruction of the anterior glenoid with iliac crest graft. We use a specific posterior glenoid guide (Arthrex, Naples, FL) for accurate graft positioning, and the bone block is introduced through the rotator interval and secured in place with 2 knotless TightRope-RT devices (Arthrex), which are adjustable-length loop devices tensioned between cortical buttons (Arthrex) with a suture tensioner (Arthrex). This knotless fixation method eliminates the use of screws and their potential problems (Video 1, Table 1). Indications and Preoperative PlanningWe consider arthroscopic reconstruction of the glenoid with iliac crest bone graft in cases with glenoid bone loss greater than 20%, in cases with glenoid bone loss between 10% and 20% in younger patients (aged <20 years) involved in competitive or contact sports, and in bipolar lesions involving the glenoid and humeral head. Patients usually undergo magnetic resonance arthrography and routinely undergo threedimensional computed tomography of the shoulder with digital subtraction of the humeral head to provide an en face sagittal view of the glenoid. The percentage of glenoid bone loss can be calculated by modeling the inferior aspect of the intact glenoid as a true circle. Iliac Crest Graft HarvestingThe tricortical iliac crest graft is harvested from the ipsilateral side with the technique described by Warner et al. 2 The dimensions of the block are usually 2 cm in length Â 1 cm in height Â 1 cm in width, although the size can be customized dependin...

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation Device

Kalogrianitis

Tsouparopoulos

2016

Arthroscopy Techniques

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“…[5][6][7][8] Another issue with the interference screw is lower stiffness, with a risk of graft slippage. 9 In our technique, fixation with a cortical button is used instead, which is a highly stiff and resistant fixation device, 10 avoiding many of the problems ascribed to the interference biodegradable screw.…”

Section: Quadruple Semitendinosus Graft Constructmentioning

confidence: 99%

Quadruple Semitendinosus Graft Construct and Suspensory Button Fixation for Anterior Cruciate Ligament Reconstruction

Silva

Sampaio

2015

Arthroscopy Techniques

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Surgical techniques for anterior cruciate ligament reconstruction are evolving, becoming less invasive, with fewer and smaller incisions, preservation of knee bone stock and tendons at the donor site, and better graft positioning and fixation. We describe an anterior cruciate ligament reconstruction technique that aims to preserve bone stock and spares the gracilis. The semitendinosus graft construct is prepared in a quadruple way and fixed with a cortical button in both tunnels, with increased stiffness and resistance of the graft construct. The tibial tunnel is filled at the end of the operation with a bone dowel, keeping the bone stock intact. This technique is safe, with a short learning curve; preserves the gracilis; saves bone; and increases the stiffness and resistance of the tibial fixation.

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“…Cortical suspension devices have been widely used in ACL reconstruction for femoral side graft fixation. Various studies have shown that cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for initial fixation of soft tissue in the femoral tunnel for ACL reconstruction [13,14,15] . Devices for tibial fixation can be divided according to the location of fixation: intratunnel fixation and extratunnel fixation.…”

Section: Introductionmentioning

confidence: 99%

A prospective study of functional outcome of ACL reconstruction with quadrupled semitendinosus tendon autograft using Endobutton and bioabsorbable interference screw

Mishra¹,

Girish²

2018

Int. J. Orthop. Sci.

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Background: The Anterior Cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. Anterior Cruciate Ligament (ACL) reconstruction is an established and widely practiced surgical procedure with proven efficacy and a low morbidity profile. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with semitendinosus grafts are availability of a greater sectional area and unaffected integrity of the extensor mechanism. Moreover tensile strength of quadrupled hamstring is found to be even better than a normal ACL. The rate of complications like extension loss, anterior knee pain and surgical site infections was also lower than other procedures like in BPTB grafts. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for initial fixation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture fixation methods like the interference screws allows for early firm fixation and heal with tight bone-tendon interface. Objectives: To evaluate functional outcome of arthroscopy assisted ACL reconstruction with quadrupled semitendinosus tendon graft using Endobutton and Bioabsorbable interference screw. Methodology: The study results included 120 patients (serving soldiers) admitted with clinical and radiological deficiency of ACL during march 2015 to march 2018, in Department of Orthopaedics, Armed Forces Medical College, Pune. Study aims to assess the functional outcome of arthroscopy assisted anterior cruciate ligament reconstruction with quadrupled semitendinosus tendon graft using Endobutton and Bioabsorbable interference screw in terms of range of motion, postoperative knee stability, graft site morbidity, subjective knee functions and prospective assessment of functional outcome using Tegner Lysholm knee scoring system. Results: All the patients included in the study were serving male soldiers. The analysis of the studied cases revealed that the most common affected age group was between 18 to 24 years (n=41, 34.2%) and the mean age was 30.53 ± 7.24 years. Majority of patients (n=76, 64.4%) were operated more than 6 months after injury. Sports/BPET (Battle Physical Efficiency Test) injuries was the most common mode of injury (n=79, 65.8%). The mean size of graft used was 8.2±0.39.Post-operatively at 02 year follow up, 08 case (6.7%) had a positive Pivot shift test with a "Glide" (Grade-I), whereas remaining 112 cases (93.3%) had a negative Pivot shift test. None of the patients had grade III laxity. The mean postoperative rolimeter measurement at 02 year follow up was 3.86±1.06 SD. The mean postoperative Lysholm score improved from pre-operative score of 66±5....

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Femoral Cortical Suspension Devices for Soft Tissue Anterior Cruciate Ligament Reconstruction

Abstract: Adjustable-length loop devices may need to be retensioned after cycling the knee and fixing the tibial side to account for the increased initial displacement seen with these devices.

Cited by 166 publications

References 23 publications

Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation Device

Arthroscopic Iliac Crest Bone Block for Reconstruction of the Glenoid: A Fixation Technique Using an Adjustable-Length Loop Cortical Suspensory Fixation Device

Quadruple Semitendinosus Graft Construct and Suspensory Button Fixation for Anterior Cruciate Ligament Reconstruction

A prospective study of functional outcome of ACL reconstruction with quadrupled semitendinosus tendon autograft using Endobutton and bioabsorbable interference screw

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