Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: a comparison between double cross-pin and suspensory graft fixation

Abstract

Femoral and tibial tunnel widening following ACL reconstruction using hamstring autograft has been described. Greater tunnel widening has been reported with suspensory fixation systems. We hypothesized that greater tunnel widening will be observed in patients whose hamstring autograft was fixated using a cortical, suspensory system, compared to double cross-pin fixation on the femur. We performed clinical and radiographic evaluation on 46 patients at minimum 2 years after primary ACL reconstruction. We measured subjective and objective outcomes including KT-1000 and AP, lateral radiographs. A musculoskeletal radiologist, independent of the surgical team, measured tunnel width, while correcting for magnification, at the widest point and at 1 cm away from tibial and femoral tunnel apertures. Patients in the suspensory graft fixation group exhibited significantly greater absolute change and greater percent change in femoral tunnel diameter compared to patients with double cross-pin fixation (P<or=0.05). This difference was noted on both AP and lateral radiographs and at both measurement sites. There was no significant difference between groups for tibial tunnel widening, IKDC subjective scores or KT-1000 side to side differences. There was significantly more femoral tunnel widening associated with the use of the endobutton suspensory fixation system compared to the use of double cross-pins for fixation within the tunnel.

Tibial tunnel widening after hamstring anterior cruciate ligament reconstructions: Comparison between Rigidfix and bio-Transfix

“…They felt that Intrafix may result in less widening of the tibial tunnel because the Intrafix sheath and screw push the 4-stranded hamstring grafts firmly against the bony tunnel wall and can improve stiffness of the graft. Baumfeld et al [13] performed 20 hamstring ACL reconstructions using Rigidfix on the femur and interference screw on the tibia. They reported 44.5 ±19.5% widening in AP and 48.0 ± 19.9% widening in lateral radiographs when measured at the widest point.…”

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

“…Patient age at the time of the primary reconstruction, sex, previous surgery in the index knee (yes, no, or missing), surgery time in minutes, meniscal resection (partial or complete resection to 1 or both menisci), chondral damage (International Cartilage Repair Society grades [3][4], and activity at primary injury (pivoting sports [soccer, handball, and basketball], nonpivoting sports, or other activities) were considered as possible confounding factors in the analysis.…”

Combined Femoral Fixation Tecnique in Hamstring Tendon Anterior Cruciate Ligament Reconstruction: Asessment of Tunnel Widening

“…Baumfeld с соавторами оценивали диа-метры каналов по данным рентгенограмм и получили среднее расширение бедренного ка-нала в группе c подвешивающим фиксатором Endobutton CL в прямой проекции -50±22,7%, в боковой проекции -55,8 ±23,9%, а в груп-пе с поперечным фиксатором Rigidfix среднее расширение составило 44,5 ±19,5% в прямой и 48±19,9% в боковой проекциях. Авторы полу-чили большее статистически значимое расши-рение канала в группе с подвешивающим кор-тикальным фиксатором [8]. В исследовании S. kuskucu с соавторами среднее расширение бедренного канала в группе с подвешивающим фиксатором Endobutton CL составило 43,7%, а в группе с поперечным фиксатором Transfix -32,61% [18].…”