Registry Data Highlight Increased Revision Rates for Endobutton/Biosure HA in ACL Reconstruction With Hamstring Tendon Autograft

Persson, Andreas; Kjellsen, Asle B.; Fjeldsgaard, Knut; Engebretsen, Lars; Espehaug, Birgitte; Fevang, Jonas

doi:10.1177/0363546515584757

Cited by 49 publications

(59 citation statements)

References 48 publications

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“…These results are in line with the recent findings of increased risk of revision within 2 years for cortical fixation compared with transfemoral fixation from the NKLR (Persson et al 2015 ). One can question the clinical relevance of a minor difference in revision risk.…”

Section: Discussionsupporting

confidence: 92%

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Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts

et al. 2017

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Background and purposeA large number of fixation methods of hamstring tendon autograft (HT) are available for anterior cruciate ligament reconstruction (ACLR). Some studies report an association between fixation method and the risk of revision ACLR. We compared the risk of revision of various femoral and tibial fixation methods used for HT in Scandinavia 2004–2011.Patients and methodsA register-based study of 38,666 patients undergoing primary ACLRs with HT, with 1,042 revision ACLRs. The overall median follow-up time was 2.8 (0–8) years. Fixation devices used in a small number of patients were grouped according to design and the point of fixation.ResultsThe most common fixation methods were Endobutton (36%) and Rigidfix (31%) in the femur; and interference screw (48%) and Intrafix (34%) in the tibia. In a multivariable Cox regression model, the transfemoral fixations Rigidfix and Transfix had a lower risk of revision (HR 0.7 [95% CI 0.6–0.8] and 0.7 [CI 0.6–0.9] respectively) compared with Endobutton. In the tibia the retro interference screw had a higher risk of revision (HR 1.9 [CI 1.3–2.9]) compared with an interference screw.InterpretationThe choice of graft fixation influences the risk of revision after primary ACLR with hamstring tendon autograft.

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Section: Discussionsupporting

confidence: 92%

“…A recent study (Persson et al. 2015 ) from the Norwegian Knee Ligament Registry (NKLR) identified combinations of fixations for HT with increased risk of revision at 2 years. In addition, a higher risk of revision when using cortical buttons compared with transfemoral or intratunnel fixations in the femur was observed.…”

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Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts

et al. 2017

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“…The combinations Endobutton/Intrafix and Endobutton/Biosure PEEK for hamstring tendon autograft femoral/tibial fixation exhibited an increased risk of revision, while the lowest risk was found among combinations used for fixation of patella tendon autografts 24. Similar results have been reported also from the NKLR,26 while two studies contradict these findings by stating that femoral fixation did not influence the risk of revision 11 17. For hamstring tendon autograft tibial fixation, the retro interference screw was associated with an increased risk of revision (HR 1.9 [95% CI 1.3 to 2.9]) compared with an interference screw 25.…”

Section: Resultssupporting

confidence: 56%

Factors associated with additional anterior cruciate ligament reconstruction and register comparison: a systematic review on the Scandinavian knee ligament registers

et al. 2018

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“… 1 , 2 , 37 , 38 , 51 As the incidence of ACL reconstruction (ACLR) has increased significantly over the past 2 decades, so too have the revision rates for this procedure, which now represent a significant surgical burden. 20 , 28 , 29 , 39 , 55 , 59 Consequently, interest has been renewed in lateral extra-articular tenodesis (LEAT) in combination with ACLR in the primary setting as a way of potentially reducing the rate of reinjury.…”

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The Role of Lateral Extra-articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis and Best-Evidence Synthesis

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et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The role of lateral extra-articular tenodesis (LEAT) to augment primary anterior cruciate ligament reconstruction (ACLR) remains controversial.Purpose:To determine whether the addition of LEAT to primary ACLR provides greater control of rotational laxity and improves clinical outcomes compared with ACLR alone and to assess the impact of early versus delayed ACLR.Study Design:Systematic review; Level of evidence, 3.Methods:Two reviewers independently searched 7 databases for randomized and nonrandomized clinical studies comparing ACLR plus LEAT versus ACLR alone. Animal, cadaveric, and biomechanical studies; revision or repair procedures; and studies using synthetic ligaments and multiligamentous-injured knees were excluded. Risk of bias was assessed with a modified Downs and Black checklist. The primary outcome was postoperative pivot shift. These data were pooled by use of a fixed-effects meta-analysis model. The studies were divided into delayed (>12 months) and early (≤12 months) reconstruction groups for meta-analysis. A best-evidence synthesis was performed on the remaining outcome measures.Results:Of 387 titles identified, 11 articles were included (5 of high quality). Meta-analysis of postoperative pivot shift in 3 studies of delayed primary ACLR showed a statistically significant difference for the pivot-shift test in favor of ACLR with LEAT (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81; P = .008; I 2 = 0). Meta-analysis of 5 studies of early primary ACLR found no statistically significant difference with the addition of LEAT (OR, 0.60; 95% CI, 0.33-1.09; P = .10; I 2 = 33%). Insufficient evidence was available to determine whether the addition of LEAT had any effect on clinical, objective, subjective, and functional outcomes.Conclusion:In primary ACLR, no evidence is available showing additional benefit of LEAT in reducing the postoperative pivot shift in early reconstructions (≤12 months); however, LEAT may have a role in delayed ACLR. Strong evidence exists that a combined ACLR and LEAT reduces lateral femoral translation, but there is insufficient evidence to identify any benefit for other clinical outcomes.

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Registry Data Highlight Increased Revision Rates for Endobutton/Biosure HA in ACL Reconstruction With Hamstring Tendon Autograft

Abstract: The choice of fixation after ACLR with an HT has a significant effect on a patient's risk of revision. In this study population, none of the examined combinations of HT fixation had a revision rate as low as that for a PT.

Cited by 49 publications

References 48 publications

Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts

Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts

Factors associated with additional anterior cruciate ligament reconstruction and register comparison: a systematic review on the Scandinavian knee ligament registers

The Role of Lateral Extra-articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis and Best-Evidence Synthesis

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