Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft

Abstract

Purpose: the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bonepatellar tendon-bone (BPtB) graft have not been established. the purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (smith & nephew, Andover, MA, UsA) after rectangular tunnel ACL reconstruction with BPtB autograft. Methods: thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPtB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (Ct) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D Ct. the clinical outcome was also assessed and correlated with the imaging outcomes. Results: the bone plug was integrated onto the femoral socket in all cases. the incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. no significant association was observed between the imaging outcomes. the postoperative mean Lysholm score was 97.1 ± 5.0 points. the postoperative side-toside difference, evaluated using a Kt-2000 arthrometer, averaged 0.5 ± 1.3 mm. there were no complications associated with EB use. imaging outcomes did not affect the postoperative Kt side-to-side difference. Conclusions: the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPtB autograft. Level of evidence: Level iV, therapeutic case series.

TightRope Versus Biocomposite Interference Screw for Fixation in Allograft ACL Reconstruction

“…Aperture and suspensory fixation remain the predominant strategies for femoral fixation of bone block grafts 6 . While aperture fixation theoretically results in less micromotion at the bone-graft interface, proponents of suspensory fixation suspect that the bone block grafts incorporate reliably with that method and without any implant remaining in the tunnel, which would be beneficial if revision reconstruction is needed 7 .…”

Length of the Tendon within the Tibial Tunnel Affects Tibial Tunnel Widening following Anatomic Anterior Cruciate Ligament Reconstruction Using a Bone–Patellar Tendon–Bone Graft

“…8,9 Briefly, the autologous BTB grafts were harvested from the central portion of the patellar tendon; these were 10 mm in width, with bone plugs at either end. 10 The femoral bone plug for a rectangular tunnel is typically 6 Â 10 Â 15 mm 3 , as described by Shino et al 11 This plug was connected to an EndoButton (Smith & Nephew Endoscopy, Andover, MA) using no. 5 FiberWire (Arthrex, Inc., Naples, FL) and no.…”

“…3 nonabsorbable sutures. 10 The tibial bone plug is typically a 10 mm diameter cylinder and its length is approximately 15 mm. This plug was connected to a small double spike plate (Smith & Nephew Endoscopy, Andover, MA) using no.…”

Bone-Patellar Tendon-Bone Autograft versus Hamstring Tendon Autograft for Anatomical Anterior Cruciate Ligament Reconstruction with Three-Dimensional Validation of Femoral and Tibial Tunnel Positions

“…3 nonabsorbable sutures. 29 The femoral insertion site for the rectangular tunnel was determined in the same manner as for DB ACLR. In creating the femoral tunnel, our priority was to position the femoral tunnel apertures as posteriorly and proximally as possible within the femoral footprint of the ACL.…”