Outcome of transtibial AperFix system in anterior cruciate ligament injuries

Abstract

Background:The anterior cruciate ligament (ACL) is one of the major stabilizing factor of the knee that resist anterior translation, valgus and varus forces. ACL is the most commonly ruptured ligament of the knee. The graft fixation to bone is considered to be the weakest link of the reconstruction. According to the parallel forces to the tibial drill hole and the quality of tibial metaphyseal bone is inferior to femoral bone stock, graft fixation to the tibia is more difficult to secure. AperFix system (Cayenne Medical, Inc., Scottsdale, Arizona, USA) which consists femoral and tibial component that includes bioinert polymer polyetheretherketone (PEEK) is one of the new choice for ACL reconstruction surgery. aim of this study was to assess the clinical outcomes and fixation durability of the AperFix (Cayenne Madical, Inc., Scottsdale, Arizona, USA) system and to determine the effect of patient's age in arthroscopic reconstruction of the anterior cruciate ligament.Materials and Methods:Patients with symptomatic anterior cruciate ligament rupture underwent arthroscopic reconstruction. Patients were evaluated in terms of range of motion (ROM) values; Lysholm, Cincinati and Tegner activity scales; laxity testing and complications. Femoral tunnel widening was assessed by computer tomography scans. Early postoperative and last followup radiographs were compared.Results:Fifty one patients were evaluated with mean followup of 29 months (range 25–34 months). Mean age at the surgery was 26.5 ± 7.2 years. Lysholm, Cincinati and Tegner activity scales were significantly higher from preoperative scores (Lysholm scores: Preoperative: 51.4 ± 17.2, postoperative: 88.6 ± 7.7 [P < 0.001]; Tegner activity scores: Preoperative 3.3 ± 1.38, postoperative: 5.3 ± 1.6 [P < 0.001]; Cincinati scores: Preoperative: 44.3 ± 17, postoperative: 81.3 ± 13.9 [P < 0.001]). The mean femoral tunnel diameter increased significantly from 9.94 ± 0.79 mm postoperatively to 10.79 ± 0.95 mm (P < 0.05). The mean ROM deficit (involved vs. contra knee) was −7.2 ± 16 (P < 0.001). There was no significant difference for knee score, ROM deficits (<30 years: −7.3 ± 15 and >30 years −7.06 ± 19) and femoral tunnel enlargement (<30 years: 0.83 ± 0.52 and >30 years 0.87 ± 0.43) of the patients with below and above 30 year. There was no significant difference for knee scores and femoral tunnel enlargement between patients with meniscal injuries and don’t have meniscus lesions.Conclusion:The AperFix system gives satisfactory clinical and radiological results with low complication rate. However, long term clinical and radiological results are needed to decide the ideal anterior cruciate ligament reconstruction method.

Comparison of proximal femoral nail and hemiarthroplasty outcomes in elderly (over 80 years old) patients with intertrochanteric fractures

“…Görmeli et al [20] found the Harris Hip Score of 74.7 in the hemiarthroplasty group and 79.7 in the PFNA group. Li et al [21] reported a Harris Hip Score of 85.6 in patients with intertrochanteric fractures to which they applied PFNA.…”

No Difference in Outcomes Between Suspensory (Fixed-Loop Cortical Button) Versus Expandable Anteromedial Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Autologous Hamstring Tendons: A Prospective, Randomized, Controlled Study in Male Patients

“… 1 , 2 , 3 , 4 , 5 Several systematic reviews and meta-analyses 6 , 7 , 8 , 9 , 10 , 11 , 12 have demonstrated either similar results 6 , 7 , 8 , 9 in terms of stability, clinical performance, and revision rates or better overall outcomes and less tunnel enlargement with suspensory, 10 aperture, 11 or intra-tunnel transfixation methods. 12 Expandable femoral fixation devices 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 recently have been introduced to theoretically provide a stronger aperture fixation with (1) circumferential compression of the hamstring’s graft at both the femoral and tibial tunnels and (2) a theoretical “double-band ACL equivalent through a single tunnel.” 19 In comparison with other fixation techniques for hamstring’s autografts, the expandable systems have shown either similar 16 , 17 , 18 or superior clinical results 20 and in some cases less tunnel enlargement, 21 especially when they are inserted through the anteromedial portal.…”

Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

“…They compare the tunnel placements and enlargements during follow-up with conventional radiographs or three-dimensional (3D) computed tomography (CT), in TT, AMP, and ACL reconstruction techniques. [8][9][10][11][12][13] To the best of our knowledge, neither the tunnel enlargement and location were evaluated with clear and objective measurements, such as 3D CT, and nor were the functional results of clinical outcomes supported by isokinetic tests.…”