Reconstruction of the anterior cruciate ligament by means of an anteromedial portal and femoral fixation using Rigidfix

Abstract

ObjectiveTo evaluate a series of patients who underwent surgery for reconstruction of the anterior cruciate ligament with flexor tendons, by means of the anteromedial transportal technique using Rigidfix for femoral fixation, and to analyze the positioning of the pins by means of tomography.MethodsThirty-two patients were included in the study. The clinical evaluation was done using the Lysholm, subjective IKDC and Rolimeter. All of them underwent computed tomography with 3D reconstruction in order to evaluate the entry point and positioning of the Rigidfix pins in relation to the joint cartilage of the lateral condyle of the femur.ResultsThe mean Lysholm score obtained was 87.81 and the subjective IKDC was 83.72. Among the 32 patients evaluated, 43% returned to activities that were considered to be very vigorous, 9% vigorous, 37.5% moderate and 12.5% light. In 16 patients (50%), the distal entry point of the Rigidfix pin was located outside of the cartilage (extracartilage); in seven (21.87%), the distal pin injured the joint cartilage (intracartilage); and in nine (28.12%), it was at the border of the lateral condyle of the femur.ConclusionThe patients who underwent ACL reconstruction by means of the anteromedial transportal using the Rigidfix system presented satisfactory clinical results over the length of follow-up evaluated. However, the risk of lesions of the joint cartilage from the distal Rigidfix pin needs to be taken into consideration when the technique via an anteromedial portal is used. Further studies with larger numbers of patients and longer follow-up times should be conducted for better evaluation.

Transportal Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Tendon Graft: A Prospective Outcome Study

“…Inácio et al . 24 in their study on ACL reconstruction by AM portal and femoral fixation using rigid fix showed mean postoperative Lysholm score as 87.81 and median subjective IKDC score as 83.72. The results of their study are comparable to our study in terms of outcome although we fixed the graft with endobutton on femoral side.…”

Safe femoral condyle range for the reverse Rigidfix femoral fixation device in anterior cruciate ligament reconstruction

“…Castoldi et al 9 found through a cadaver study using the Rigid x system to prepare a femoral tunnel through the AM portal that as the insertion angle of the pin increases, the risk of chondral injury increases from 80% to 100%. Inácio et al 28 also found that in postoperative CT threedimensional reconstruction after Rigid x femoral xation through the AM portal for ACLR, the chondral injury rate was as high as 49.99%. However, what is more dangerous is that with the increase in the insertion angle of the femoral tunnel, the cross-pins may penetrate from the posterior cortex to the popliteal fossa, causing damage to important vessels and nerves in the popliteal fossa.…”

“…Moreover, other studies have shown that the knee joint after ACLR exhibits better rotational stability by femoral tunnel positioning by the AM technique than by the TT technique. [22][23][24][25][26] Therefore, some scholars have tried to use the cross-pin femoral xation device to prepare the femoral tunnel through the AM portal, 3,23,[27][28][29][30] but iatrogenic injury caused by cross-pin tunnels prepared from the outside to the inside is major, especially chondral injury. Castoldi et al 9 found through a cadaver study using the Rigid x system to prepare a femoral tunnel through the AM portal that as the insertion angle of the pin increases, the risk of chondral injury increases from 80% to 100%.…”

Safe femoral condyle range for the reverse Rigidfix femoral fixation device in anterior cruciate ligament reconstruction

“…Castoldi et al [ 9 ] found through a cadaver study using the Rigidfix system to prepare a femoral tunnel through the AM portal that as the insertion angle of the pin increases, the risk of chondral injury increases from 80 to 100%. Inácio et al[ 28 ] also found that in postoperative CT three-dimensional reconstruction after Rigidfix femoral fixation through the AM portal for ACLR, the chondral injury rate was as high as 49.99%. However, what is more dangerous is that with the increase in the insertion angle of the femoral tunnel, the cross-pins may penetrate from the posterior cortex to the popliteal fossa, causing damage to important vessels and nerves in the popliteal fossa [ 10 ].…”