Suspensory Versus Aperture Fixation of a Quadrupled Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysis

Browning, William M.; Kluczynski, Melissa A.; Curatolo, Christian; Marzo, John M.

doi:10.1177/0363546516680995

Cited by 63 publications

(76 citation statements)

References 84 publications

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“…A recent meta-analysis by Browning et al. ( 2017 ) included 41 clinical level 1–4 studies comparing clinical outcome for patients treated with an ACLR with 4-strand hamstring autograft using either suspensory or aperture fixation. They found better arthrometric stability and fewer graft ruptures using suspensory compared with aperture fixation at a minimum of 2-year follow-up; however, they included graft fixation in the femur with cross-pins in the suspensory group.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Thus, we hypothesized that an analysis of the comparison studies would provide some valuable insights into the ongoing debate. Browning et al had systematically reviewed ACLR using suspensory or aperture xation and found that the suspensory device engendered better knee stability and less graft failure (21). Recently, with the evolution of surgical instruments and techniques, suspensory devices are used in most all-inside ACLRs.…”

Section: Discussionmentioning

confidence: 99%

Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis

Chen

2020

Preprint

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Background To compare the clinical results of all-inside anterior cruciate ligament reconstruction (ACLR) using suspensory cortical button fixation and full tibial tunnel drilling Methods Systematic searches were conducted of published literature up to November 2019 on PubMed, Embase, and Cochrane for studies comparing all-inside ACLR using suspensory cortical button fixation and full tibial tunnel ACLR. Two reviewers independently determined eligibility, extracted the outcome data, and assessed the risk of bias of the eligible studies. The clinical outcome and graft reruptures were pooled by using random effects with mean differences and risk ratios for continuous and dichotomous variables, respectively. Result A total of nine studies (five randomized controlled trials and four comparative studies) involving 613 patients were included in the meta-analysis. The postoperative functional outcome, knee laxity measured with arthrometer, and graft reruptures were comparable between patients with all-inside ACLR using suspensory cortical button fixation and full tibial tunnel ACLR. However, a significantly greater thickness of autologous tendon was used and less change in drilling tunnel diameter was noted in patients with suspensory cortical button graft fixation.Conclusions All-inside ACLR with suspensory cortical button fixation was not clinically superior to full tibial tunnel ACLR with interference screw fixation in functional outcomes, knee laxity measured with arthrometer, or rerupture rate. However, the advantage of using suspensory cortical button fixation was that a thicker graft could be used for reconstruction, and brought less tibia tunnel widening compared with bioabsorbable interference screw fixation.

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“…37 A recent meta-analysis by Browning et al revealed that there was significantly better knee stability in the suspensory fixation group compared with the aperture fixation group and the graft rupture rate was lower with suspensory fixation compared with aperture fixation. 38 The security of the graft is more reliant on tunnel wall integrity at aperture fixation than suspensory fixation. This might explain why there was better knee stability in the suspensory fixation group and reconfirmed that tendonto-bone healing was not always necessary for clinical stability of the knee joint.…”

Section: Discussionmentioning

confidence: 99%

Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results

et al. 2018

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Most studies concerning to tendon healing and incorporation into bone are mainly based on animal studies due to the invasive nature of the biopsy procedure. The evidence considering tendon graft healing to bone in humans is limited in several case series or case reports, and therefore, it is difficult to understand the healing process. A computerized search using relevant search terms was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies that investigated tendon graft healing to bone by histologic examination after anterior cruciate ligament (ACL) reconstruction with hamstring. Ten studies were determined to be eligible for this systematic review. Thirty-seven cases were extracted from the included studies. Most studies showed that a fibrovascular interface would form at the tendon-bone interface at the early stage and a fibrous indirect interface with Sharpey-like fibers would be expected at the later stage. Cartilage-like tissue at tendon graft-bone interface was reported in three studies. Tendon graft failed to integrate with the surrounding bone in 10 of the 37 cases. Unexpectedly, suspensory type of fixation was used for the above failure cases. An indirect type of insertion with Sharpey-like fibers at tendon-bone interface could be expected after ACL reconstruction with hamstring. Regional cartilage-like tissue may form at tendon-bone interface occasionally. The underlying tendon-to-bone healing process is far from understood in the human hamstring ACL reconstruction. Further human studies are highly needed to understand tendon graft healing in bone tunnel after hamstring ACL reconstruction.

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Suspensory Versus Aperture Fixation of a Quadrupled Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Meta-analysis

Cited by 63 publications

References 84 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

Is all-inside with suspensory cortical button fixation a superior technique for anterior cruciate ligament reconstruction surgery? A systematic review and meta-analysis

Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results

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