Migration of EndoButton After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Mae, Tatsuo; Kuroda, S.; Matsumoto, Nobuyoshi; Yoneda, Minoru; Nakata, Ken; Yoshikawa, Hideki; Shino, Konsei

doi:10.1016/j.arthro.2011.06.024

Cited by 54 publications

(76 citation statements)

References 21 publications

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“…Of these six cases, five were in the AM group and one was in the TT group. When comparing the patients with device fixation on soft tissues with those with no fixation on soft tissues, there were no objective and subjective clinical differences, corroborating the findings of a published clinical study 26 assessing whether fixation of the endobutton on soft tissues or its migration would lead to worse clinical outcomes compared with patients without this complication. A total of 25.2% of the cases assessed had soft tissue interposition but with no clinical implications.…”

Section: Discussionsupporting

confidence: 74%

Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Guglielmetti

Cury

Oliveira

et al. 2016

Rev Bras Med Esporte

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Introduction: Although the results of anterior cruciate ligament (ACL) reconstruction are well documented in many studies, with good to excellent outcomes in most cases, some issues like tunnel positioning are still discussed and studied. Objective: To compare the objective and subjective clinical outcomes of ACL reconstruction using the transtibial and anteromedial portal techniques. Methods: Prospective randomized study of 80 patients undergoing anterior cruciate ligament reconstruction by the same surgeon, with 40 patients operated by the transtibial technique and 40 by anteromedial portal technique. The patients, 34 in the transtibial group and 37 in the anteromedial portal group (nine dropouts), were reassessed during a 2-year follow-up period. The clinical assessment consisted of physical examination, KT-1000TM evaluation, Lysholm score, and objective and subjective International Knee Documentation Committee -IKDC scores. Results: Regarding the Lachman and pivot shift tests, we observed more cases of instability in the transtibial group, but with no statistical significance (p=0.300 and p=0.634, respectively). Regarding the anterior drawer test, the groups presented similar results (p=0.977). Regarding KT-1000TM evaluation, the mean results were 1.44 for the transtibial group and 1.23 for the anteromedial portal group, with no statistical significance (p=0.548). We separated the objective IKDC scores into two groups: Group 1, IKDC A, and Group 2, IKDC B, C, or D, with no statistical significance (p=0.208). Concerning the Lysholm score, the transtibial group had a mean score of 91.32, and the anteromedial portal group had a mean score of 92.81. The mean subjective IKDC scores were 90.65 for the transtibial group and 92.65 for the anteromedial portal group. Three re-ruptures were encountered in the transtibial group and three in the anteromedial portal group. Conclusions: There were no significant differences in the subjective and objective clinical assessments among patients submitted to anterior cruciate ligament reconstruction using the transtibial or anteromedial portal techniques.

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Section: Discussionsupporting

confidence: 74%

Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Guglielmetti

Cury

Oliveira

et al. 2016

Rev Bras Med Esporte

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“…There have been several case reports documenting the potential complications of utilizing cortical suspensory fixation for ACL surgery, in particular device malpositioning or soft tissue interposition between the device and the femoral cortex during fixation. [24][25][26][27] Simonian et al noted a case where the device was fixed 10 mm off of the lateral femoral cortex, with soft tissue interposition between the device and the cortex. 24 Muneta et al reported a case where the device was away from the lateral femoral cortex and was "flipped" within the popliteal space.…”

Section: Discussionmentioning

confidence: 99%

Is Intraoperative Fluoroscopy Necessary to Confirm Device Position for Femoral-Sided Cortical Suspensory Fixation during Anterior Cruciate Ligament Reconstruction?

Balldin¹,

Nuelle²,

DeBerardino³

2019

J Knee Surg

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Increased laxity within the graft construct system can lead to graft failure after anterior cruciate ligament (ACL) reconstruction. Suboptimal cortical device positioning could lead to increased laxity within the system, which could influence the mechanics and function of the graft reconstruction. This study evaluates the benefit of intraoperative fluoroscopy to confirm device position on the femur during ACL reconstruction using cortical suspensory fixation. One hundred consecutive patients who underwent soft tissue ACL reconstruction using a suspensory cortical device for femoral fixation were retrospectively evaluated. Patients were split into two groups: Group A utilized anteromedial portal visualization and had intraoperative fluoroscopic imaging performed at the time of ACL graft fixation to confirm femoral device placement on the lateral femoral metaphyseal cortex. Group B utilized anteromedial portal visualization alone. Both groups had radiographic X-rays performed at the first postoperative visit to evaluate device location and all images were independently evaluated by three fellowship trained orthopaedic surgeons. Device position was classified as optimal if there was complete apposition of the entire device against the femoral cortex and suboptimal if it was > 2 mm off the cortex. Fisher's exact test, analysis of variance, and 95% confidence intervals were calculated to compare the groups for statistical significance. The results showed 0/60 (0%) patients in group A had suboptimal device position at postoperative follow-up, while 4/40 (10%) patients in group B had suboptimal device position (p = 0.013). There were no graft failures in group A and one graft failure in group B. There was a significant difference in cortical device position in patients who had intraoperative fluoroscopic imaging versus patients who had no intraoperative imaging. The use of confirmatory intraoperative imaging may be beneficial to confirm appropriate device location when using a femoral cortical suspensory fixation technique for ACL reconstruction.

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“…According to previous studies, malpositioning of the EndoButton may lead to either soft-tissue irritation or migration of the button. [3][4][5][6] In addition, a previous study indicated that a rate of soft-tissue interposition between the EndoButton and the lateral cortex of the femur would be up to 25.2% on postoperative radiographs obtained after ACL reconstruction. 4 A positive correlation between this complication and a higher rate of button migration was also seen.…”

Section: Discussionmentioning

confidence: 99%

Self-flip Technique of the TightRope RT Button for Soft-Tissue Anterior Cruciate Ligament Reconstruction

Harato

Niki

Toyoda

et al. 2016

Arthroscopy Techniques

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The TightRope RT (Arthrex, Naples, FL) is a suspensory device for anterior cruciate ligament reconstruction. However, there is a potential risk of the button being pulled too far off the lateral femoral cortex into the soft tissue because the adjustable loop is long. The purpose of this article is to present an easy and safe technique for self-flip. As to the preparation of the graft, we draw the first line in the loop of the TightRope RT at the same length as the femoral tunnel, and we draw the second line 7 mm longer than the length of the femoral tunnel as a self-flip line. Concerning passing of the graft, the side sutures are pulled from the lateral side. We stop pulling the sutures just at the self-flip line by holding the graft at the tibial end. The side suture is inclined to the medial side with strong pulling of the suture at full extension of the knee. Then the surgeon pulls the tibial end of the graft to feel a secure positioning of the button on the lateral femoral cortex. Although it has limitations, the present technique is easy and certainly helps surgeons achieve appropriate positioning of the button.

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Migration of EndoButton After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Cited by 54 publications

References 21 publications

Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Transtibial Versus Anteromedial Portal Techniques in Acl Reconstruction

Is Intraoperative Fluoroscopy Necessary to Confirm Device Position for Femoral-Sided Cortical Suspensory Fixation during Anterior Cruciate Ligament Reconstruction?

Self-flip Technique of the TightRope RT Button for Soft-Tissue Anterior Cruciate Ligament Reconstruction

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