Femoral fixation methods for hamstring graft in anterior cruciate ligament reconstruction: A network meta-analysis of controlled clinical trials

Abstract

Objective To compare the clinical effectiveness of cortical button (CB), cross-pin (CP) and compression with interference screws (IS) fixation techniques in anterior cruciate ligament (ACL) reconstruction using hamstring graft. Methods Studies were systematically retrieved from PubMed, Embase, Cochrane Library and Web of Science up to May 20, 2021. Primary outcomes were KT-1000 assessment, International Knee Documentation Committee (IKDC) score A or B, Lachman’s test, pivot-shift test, visual analogue scale (VAS) score, Lysholm score, Tegner score, and Cincinnati Knee Score. Secondary outcomes included reconstruction failures and synovitis. League tables, rank probabilities and forest plots were drawn for efficacy comparison. Results Twenty-six controlled clinical trials (CCTs) with 1,824 patients undergoing ACL reconstruction with hamstring graft were included. No significant differences were found among CB, CP and IS fixation methods regarding the 10 outcomes. For KT-1000 assessment, IKDC score A or B, Lachman’s test, VAS score and pivot-shift test, CP had the greatest probability of becoming the best method, and IS may be the suboptimal method in 4 out of these 5 outcomes except pivot-shift test. Conclusions CP, CB and IS fixations have comparable clinical performance, while CP fixation is most likely to be the optimum fixation technique for hamstring graft in ACL reconstruction. Future larger-sample studies of high quality comparing these techniques in more clinical outcomes are required.

Current trends in graft choice for anterior cruciate ligament reconstruction – part I: anatomy, biomechanics, graft incorporation and fixation

“…At this point, there is no clear consensus regarding the “best” graft fixation method, as each option has advantages and disadvantages. Several recent meta-analyses [ 20 , 24 , 53 , 82 , 106 ] and network meta-analyses [ 53 , 129 ] have demonstrated no superiority in clinical or patient-reported outcomes (PROs) of any particular fixation method. However, a recent meta-analysis of 40 studies found improved arthrometric stability and fewer graft ruptures but no difference in PROs using suspensory- compared to interference screw fixation for quadrupled HT autograft [ 15 ].…”

Outcomes of RigidFix Cross Pin Fixation in Femoral and Tibial Tunnel for Anterior Cruciate Ligament Reconstruction

“…In practice, RigidFix cross pins have been used for femoral tunnel fixation widely and achieved satisfactory results. 11,27,[32][33][34][35][36] Persson et al found that RigidFix had a lower risk of revision compared with the Endobutton. 34 Snaebjörnsson et al's study also showed the RigidFix cross pins system entailed a lower risk of ACL revision compared with other femoral fixations.…”

“…8 In addition, successful ACLR requires graft stability in the immediate postoperative period 9 and tendon-bone healing in the anatomic tunnel. 10,11 This is especially true for the tibial graft fixation, which has been considered the weakest link of the reconstruction 12 due to the lower density of the tibial bone and the parallel graft-fixation associated with the tunnel. 13 The tibial grafts are usually fixed with interference screws 14,15 as they were easy to place, however the tibial interference screws sometimes have complications such as slippage and cysts.…”

“…Large graft size was discovered to be an important factor in lowering ACL failure rates 8 . In addition, successful ACLR requires graft stability in the immediate postoperative period 9 and tendon‐bone healing in the anatomic tunnel 10,11 . This is especially true for the tibial graft fixation, which has been considered the weakest link of the reconstruction 12 due to the lower density of the tibial bone and the parallel graft‐fixation associated with the tunnel 13 .…”

“…Hence, the tibial tunnel fixation should be further studied 24,25 . Inspired by the successful application of RigidFix (DePuy Mitek, Raynham, MA, USA) in the femoral tunnel, 11 we applied RigidFix cross pins to the tibial tunnel in the hope of achieving large graft size and better clinical results.…”