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Abed Ali A, Pettinari F, Alayane A, Barosso M, Osório TF, Vieira TD, Patt T, Sonnery-Cottet B. Arthroscopic Confirmation of Femoral Button Deployment During Posterior Cruciate Ligament Reconstruction. Arthrosc Tech 2024; 13:102978. [PMID: 39036411 PMCID: PMC11258917 DOI: 10.1016/j.eats.2024.102978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/03/2024] [Indexed: 07/23/2024] Open
Abstract
Posterior cruciate ligament (PCL) ruptures are uncommonly seen in knee ligament injuries. Cconservative treatment is often suitable for isolated tears with mild-to-moderate posterior knee laxity (grades I or II). However, surgical intervention is indicated for symptomatic grade III or multiligament knee injuries. PCL reconstruction has experienced continuous development due to the progress made in arthroscopic techniques and instruments. Abnormal positioning and tensioning of the femoral button result in multiple complications such as residual laxity, loss of quadriceps muscle strength, and joint stiffness. In this Technical Note, we describe direct arthroscopic visualization of the femoral button deployment in PCL reconstruction technique, and we discuss its importance to prevent complications related to button malposition.
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Affiliation(s)
- Ahmad Abed Ali
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Francesco Pettinari
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Ali Alayane
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Marta Barosso
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Tomás Freitas Osório
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
| | | | - Bertrand Sonnery-Cottet
- Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Ramsay Générale de Santé, Lyon, France
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Tsujii A, Takami H, Sato S, Mae T, Ohori T, Tanaka H, Okada S, Nakata K. Deep Infection After Anterior Cruciate Ligament Reconstruction Diagnosed by Intratunnel Suspensory Fixation Device Migration: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00003. [PMID: 37797166 DOI: 10.2106/jbjs.cc.23.00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
CASE A 43-year-old woman sustained an anterior cruciate ligament injury while kickboxing and underwent anterior cruciate ligament reconstruction with hamstring autograft with suspensory fixation. Lateral thigh wound was superficially infected at 2 weeks postoperatively with resolution of signs and symptoms after debridement. Three months later, posterolateral knee pain developed and radiographs revealed intratunnel migration of the device. That observation with abnormal magnetic resonance imaging and serology results led to the diagnosis of deep infection. Immediate device removal and debridement were performed. Consequently, the grafts were preserved, and the patient could perform kickboxing 2 years thereafter. CONCLUSIONS Intratunnel migration of suspensory fixation devices can support a diagnosis of infection.
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Affiliation(s)
- Akira Tsujii
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Haruna Takami
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Seira Sato
- Department of Sports Medical Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Sports Medical Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ken Nakata
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, Osaka, Japan
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Özbek EA, Kocaoğlu H, Karaca MO, Terzi MM, Dursun M, Akmeşe R. Effect of Soft Tissue Interposition and Postoperative Suspensory Cortical Button Migration on Functional Outcomes and Ligamentization After Single-Bundle ACL Reconstruction. Orthop J Sports Med 2022; 10:23259671221122748. [PMID: 36157085 PMCID: PMC9490472 DOI: 10.1177/23259671221122748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR). Purpose: To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity. Results: There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (<3 mm) was detected in 83.7% of the patients postoperatively, and all patients showed statistically significant pre- to postoperative improvement on the Tegner (from 4.1 to 4.3) and Lysholm (from 44.0 to 89.2) scores (P < .05 for both). No significant difference in postoperative functional results or graft ligamentization was found between either the soft tissue interposition groups (groups 1 and 2) or the suspensory cortical button migration groups (groups M and non-M). Conclusion: Differences between patients in soft tissue interposition and suspensory cortical button migration did not significantly affect postoperative clinical or functional outcomes or graft ligamentization after single-bundle ACLR.
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Affiliation(s)
- Emre Anıl Özbek
- Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey
| | - Hakan Kocaoğlu
- Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey
| | | | - Mustafa Mert Terzi
- Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey
| | - Merve Dursun
- Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey
| | - Ramazan Akmeşe
- Orthopedics and Traumatology Department, Haliç University, Istanbul, Turkey
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Yuanjie Z, Xing X, Jing W, Xi G, Yanbin P, Yu M. Risk Factors for Femoral Cortical Button Malposition in Posterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221094292. [PMID: 35547612 PMCID: PMC9083064 DOI: 10.1177/23259671221094292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Femoral cortical button suspension fixation is a popular and reliable technique for posterior cruciate ligament reconstruction (PCLR). Button malposition during graft fixation can lead to postoperative graft loosening. Purpose To determine the risk factors of femoral cortical button malposition in PCLR when neither direct visualization nor intraoperative fluoroscopy is used. Study Design Case-control study; Level of evidence, 3. Methods Of the 206 consecutive patients who underwent PCLR without direct visualization or intraoperative radiographs in 2019 at a single institution, 182 met the selection criteria and were included in the study. The distance from the suspension button to the femoral cortex was measured on postoperative computed tomography scans. The button was considered malpositioned if its distance to the femoral cortex was ≥2 mm. We evaluated patient-related and surgery-related variables, including age, sex, concomitant ligament reconstruction, button type, and surgeon experience. Multivariate logistic regression was conducted to evaluate the risk factors for button malposition. Results The overall prevalence of button malposition was approximately 17.0% (31/182), and the mean distance from the button to the femoral cortex was 6.11 ± 5.82 mm in the malposition group. Male sex was the most significant risk factor for button malposition (odds ratio [OR], 13.86; 95% confidence interval [CI], 1.73-111.17; P = .013). Other independent risk factors were low surgical volume (completing ≤3 procedures; OR, 6.41; 95% CI, 1.89-21.72; P = .003), concomitant ligament reconstruction (OR, 5.56; 95% CI, 2.12-14.58; P < .001), and fixed-loop button (OR, 3.96; 95% CI, 1.11-14.18; P = .034). Conclusion Male sex, low surgical volume, concomitant ligament reconstruction, and fixed-loop button were independent risk factors for femoral cortical button malposition during PCLR.
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Affiliation(s)
- Zeng Yuanjie
- Joint Surgery and Sport Medicine Department, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Hunan Province Sports Medicine Clinical Medicine Research Center, Changsha, China
| | - Xie Xing
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Wang Jing
- Joint Surgery and Sport Medicine Department, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Hunan Province Sports Medicine Clinical Medicine Research Center, Changsha, China
| | - Gong Xi
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Pi Yanbin
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Mei Yu
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
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Guy S, Carrozzo A, Ferreira A, Vieira TD, Freychet B, Thaunat M, Sonnery-Cottet B. Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:2251-2258. [PMID: 34665299 PMCID: PMC8523932 DOI: 10.1007/s00167-021-06758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to determine whether direct arthroscopic control of femoral buttons can prevent improper deployment and soft tissue interposition in anterior cruciate ligament (ACL) reconstruction. METHODS A retrospective analysis of prospectively collected data from the SANTI study group database was performed. All patients who underwent ACL reconstruction using suspensive femoral fixation between 01/01/2017 and 31/12/2019 were included. Patient assessment included demographics, sports metrics, reoperations performed and femoral button-related specific complications such as iliotibial band (ITB) irritation and/or septic arthritis. Proper deployment of the button and soft tissue interposition were assessed on postoperative radiographs. RESULTS A total of 307 patients underwent ACL reconstruction using adjustable femoral button fixation and were analyzed after a mean follow-up of 35.2 ± 11.0 months (14.3-50.2). The mean age was 39.5 ± 10.9-years old (range 13.3-70.6). Postoperative radiographs showed a correctly deployed femoral button without soft tissue interposition for all patients. No septic arthritis was reported. Nine patients (2.9%) suffered from lateral pain related to ITB irritation due to the button. Five of them had their symptoms resolve during rehabilitation. Ultrasound-guided corticosteroid infiltration was necessary for four patients after an average delay of 14.5 ± 4.8 months (11.7-21.7). Three patients were then symptom-free, but one required surgical removal of the implant 27.5 months after the surgery. Regarding unrelated femoral button complications, 15 patients (4.9%) underwent secondary arthroscopic procedures, including meniscectomy (1.6%), surgery for cyclops syndrome (2.6%) and revision ACLR (0.7%). CONCLUSION Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition without specific complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sylvain Guy
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Alessandro Carrozzo
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Alexandre Ferreira
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Thais Dutra Vieira
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France.
| | - Benjamin Freychet
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Mathieu Thaunat
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Bertrand Sonnery-Cottet
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
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Yassa R, Adam JR, Charalambous CP. Complications following Suture Button Use for Femoral Graft Fixation in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Systematic Review. J Knee Surg 2021; 34:755-763. [PMID: 31905415 DOI: 10.1055/s-0039-3400753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Understanding any potential complications that may occur in relation to the use of a suture button for femoral graft fixation in arthroscopic anterior cruciate ligament reconstruction can help raise awareness among surgeons and improve safety when using such implants. This is a systematic review of suture button related complications. A literature search was conducted using the PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases from their year of inception until January 3, 2019. We included studies reporting on suture button related complications in their outcomes of femoral graft suture button fixation in anterior cruciate ligament reconstruction. Our search identified 479 articles, of which 19 met our inclusion criteria. Suture button misplacement (initial or subsequent migration) was the most commonly reported complication. Although, in most cases, button misplacement is minimal and does not adversely affect clinical outcomes, in some cases it may lead to graft failure or local soft tissue irritation and require further surgery. Intraoperative screening or arthroscopic evaluation of the deployed suture button may reduce this complication.
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Affiliation(s)
- R Yassa
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - J R Adam
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - C P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom.,School of Medicine, University of Central Lancashire, Preston, United Kingdom
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Matassi F, Sani G, Innocenti M, Giabbani N, Civinini R. Arthroscopic confirmation of femoral button deployment avoids post-operative X-ray in ACL reconstruction. PHYSICIAN SPORTSMED 2021; 49:171-175. [PMID: 32669026 DOI: 10.1080/00913847.2020.1796469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) with cortical fixation adjustable-loop devices are associated with high potential risk of button malpositioning or interposition of the soft tissue between lateral femoral cortex and the button. Surgeons usually use X-rays to check and avoid button malposition and soft tissue interposition. Arthroscopic visualization of button position through the lateral gutter has been described. With this technique, it is possible for identification and correction of femoral button malalignment in the setting of soft tissue interposition and it could avoid the use of post-operative X-ray. METHODS A total of 193 ACLR were included and patients were randomized into two groups. The first series (Group A) of 112 patients who sustained an ACLR with post-operative X-ray to assess the position of the femoral button and the second series (Group B) of 81 patients who sustained an ACLR with an arthroscopic exploration of the button followed by post-operative X-ray. RESULTS On the post-operative radiographs, tissue interposition between the button and femoral cortex was found in nine cases of 112 in Group A (8%) and in zero case of 81 in Group B (0%). In six cases (7,4%) in Group B, there was a soft tissue interposition between the button and femoral cortex as visualized by arthroscopic confirmation and before post-operative X-ray; in all these cases, the soft tissue was removed, and the button was in contact with the bone in all X-ray made in the Group B. CONCLUSIONS This technique allows for identification and correction of femoral button malalignment in the setting of soft tissue interposition and reduces the use of post-operative X-ray.
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Affiliation(s)
- Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Giacomo Sani
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Niccolò Giabbani
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
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Gürpınar T, Polat B, Eren M, Çarkçı E, Özyalvaç ON, Erdoğan S. The effect of soft tissue interposition of the Endobutton on clinical results and on its postoperative migration after single-bundle anterior cruciate ligament reconstruction. Knee 2020; 27:1980-1987. [PMID: 33248352 DOI: 10.1016/j.knee.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 08/29/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to investigate the possible consequences of soft tissue interposition of Endobutton on clinical outcomes and reoperation rates after anterior cruciate ligament reconstruction. METHODS We measured the distance between the centre of the Endobutton and the lateral femoral cortex on the postoperative first day anteroposterior X-rays of the 156 knees that underwent anterior cruciate ligament reconstruction. Those with a distance less than 1 mm were regarded as Group 1 (118 patients), the ones between 1 mm and 2 mm were regarded as Group 2 (30 patients) and the ones more than 2 mm were regarded as Group 3 (8 patients). The movement of the Endobutton of more than 1 mm along the femoral tunnel axis on anteroposterior X-rays or its rotation by more than 5° on lateral X-rays during follow-up were considered migration. Clinical assessment scores (Lysholm, Tegner Activity Scale), clinical examination tests, and rates of Endobutton migration in the groups were analysed. RESULTS Eleven Endobuttons (9.3%) in Group 1, 26 Endobuttons (86.7%) in Group 2 and all of the 8 Endobuttons (100%) in Group 3 were observed to have migrated. Clinical results and examination tests showed no significant difference between Groups 1 and 2, whereas a significant difference was detected in Group 3 compared to Groups 1 and 2 (p < 0.05). CONCLUSION Soft tissue interposition is a major cause of Endobutton migration, and an interposition over 2 mm between the Endobutton and the lateral femoral cortex can negatively affect the outcomes after an anterior cruciate ligament surgery.
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Affiliation(s)
- Tahsin Gürpınar
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Barış Polat
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus.
| | - Murat Eren
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Engin Çarkçı
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Osman Nuri Özyalvaç
- Department of Orthopaedics and Traumatology, Baltalimanı Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Sinan Erdoğan
- Department of Orthopaedics and Traumatology, Baltalimanı Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
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Sohn S, Koh IJ, Kim MS, In Y. Confirmation of Femoral Button Deployment Under Direct Visualization During ACL Reconstruction Is Not Beneficial. Orthopedics 2020; 43:270-276. [PMID: 32745225 DOI: 10.3928/01477447-20200721-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to determine whether direct visualization of adjustable-loop cortical suspensory button deployment onto the lateral femur increases the cortical contact rate of the button, thereby improving clinical outcomes after anterior cruciate ligament (ACL) reconstruction. Sixty-five single-bundle anteromedial portal ACL reconstructions using an adjustable-loop button were retrospectively divided into 2 groups according to use of the blind pulling technique (control group; 32 patients) or the direct visualization technique (visualization group; 33 patients) when confirming deployment of the button. Cortical contact rate of the button on immediate and 2-year postoperative radiographs, knee stability measured using a KT-1000 arthrometer, and functional scores (Lysholm score and International Knee Documentation Committee score) at 2 years postoperative were compared between the groups. There was no significant difference in femoral cortical contact rate between the groups immediately (56% control group vs 55% visualization group; P=1.000) and at 2 years postoperative (78% control group vs 82% visualization group; P=.764). At 2 years postoperative, there was no difference between the groups regarding knee stability (1.3±0.9 mm vs 1.5±0.8 mm, respectively; P=.404), Lysholm score (P=.436), and International Knee Documentation Committee score (P=.507). Confirmation of adjustable-loop button deployment under direct visualization during anteromedial portal ACL reconstruction neither increased cortical contact rate nor improved clinical outcomes. [Orthopedics. 2020;43(5);270-276.].
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Buyukkuscu MO, Misir A, Cetinkaya E, Ezici A, Ozcafer R, Gursu SS. The interposition of soft tissue between the cortical button and femoral lateral cortex significantly increases button migration but does not negatively affect knee stability and clinical outcome. Knee 2020; 27:891-898. [PMID: 32201042 DOI: 10.1016/j.knee.2020.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/01/2020] [Accepted: 02/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In clinical practice, soft tissue interposition may occur during femoral graft fixation. Soft tissue interposition between the lateral femoral cortex and the cortical button may affect graft tension and related longitudinal graft motion in the tunnel. We aimed to investigate the effect of soft tissue interposition on button migration and clinical outcomes in anatomical single-bundle anterior cruciate ligament reconstruction. METHODS Eighty-four patients aged 18-40 years, who underwent anatomical single-bundle anterior cruciate ligament reconstruction with quadruple hamstring autograft were included. Patients were divided into two groups as Group 1 (n = 32) with soft tissue interposition between the cortical button and cortex, and Group 2 (n = 52) without soft tissue interposition. At the one-year follow-up visit, the anteroposterior knee stability of the patients was evaluated using the Lachman test and KT-2000 arthrometer, and rotational stability was assessed with the pivot shift test. The Lysholm knee score was used to evaluate the functional outcome of the patients. Relationship between tissue interposition and clinical outcome, and button migration was examined. RESULTS Button migration was observed in 12 patients in Group 1 (37.5%) and two patients (3.84%) in Group 2 (p < 0.001). However, no significant difference was observed between patients with and without tissue interposition or those with and without button migration regarding knee stability parameters and clinical outcome (p < 0.05). CONCLUSIONS Postoperative tissue interposition is found to be associated with cortical button migration during the follow-up. However, it does not affect the clinical outcome.
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Affiliation(s)
- Mehmet Ozbey Buyukkuscu
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey.
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Engin Cetinkaya
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Atakan Ezici
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Rasit Ozcafer
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Sukru Sarper Gursu
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
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Doss W, Osborn N, McCormack R, Ruotolo C. Direct Visualization of the Femoral Cortical Button in Anterior Cruciate Ligament Reconstruction Helps Ensure Proper Positioning. Orthopedics 2020; 43:191-195. [PMID: 32003840 DOI: 10.3928/01477447-20200129-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/14/2019] [Indexed: 02/03/2023]
Abstract
This study sought to postoperatively compare femoral cortical button (FCB) placement in anterior cruciate ligament (ACL) reconstruction performed using an adjustable loop cortical femoral fixation button under direct arthroscopic visualization vs indirect methods. The authors conducted a retrospective review of postoperative knee radiographs from 76 patients who had undergone ACL reconstruction with an adjustable loop cortical femoral fixation button. Operative reports were reviewed to determine the technique used for graft placement. Two sports fellowship-trained surgeons reviewed the collected radiographs, and the position of the FCB in each patient was subsequently graded. Of the 76 patients reviewed, 42 cases were performed using direct visualization, whereas 34 cases used indirect methods. This analysis showed that FCBs placed with direct visualization were more likely to have optimal position directly on the femoral cortex compared with indirect methods (chi-square test, P=.046). The grading scores demonstrated moderate strength of interobserver reliability (kappa coefficient=0.62). Direct arthroscopic visualization while placing an FCB during ACL reconstruction with an adjustable loop cortical fixation button can help ensure optimal button placement. [Orthopedics. 2020;43(3):191-195.].
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Late Migration of an Adjustable-Loop Cortical Suspension Device in Anterior Cruciate Ligament Reconstruction. Case Rep Orthop 2019; 2019:1061385. [PMID: 31531256 PMCID: PMC6721472 DOI: 10.1155/2019/1061385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/08/2019] [Accepted: 06/27/2019] [Indexed: 01/13/2023] Open
Abstract
A unique case of late migration of an adjustable-loop femoral fixation button utilized during anterior cruciate ligament (ACL) reconstruction is presented. Imaging and physical examinations during the patient's postoperative course were unremarkable for graft or hardware failure. Two years postoperatively, symptomatic hardware migration occurred requiring arthroscopic removal. To our knowledge, this is the first reported case of late migration of an adjustable-loop femoral fixation button in ACL reconstruction. This case highlights that late loosening and migration of adjustable-loop femoral fixation devices in ACL reconstruction can occur despite demonstrated postoperative radiographic and clinical stability. Surgeons utilizing this fixation device should be aware of this potential complication to avoid delayed recognition and patient morbidity.
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Perumal R, Gunasekaran C, Jacob M, Jepegnanam TS. Alternate Method of Arthroscopically Confirming Femoral Button Deployment for Knee Anterior Cruciate Ligament Graft Suspensory Cortical Fixation. Arthrosc Tech 2018; 7:e1295-e1298. [PMID: 30591877 PMCID: PMC6305945 DOI: 10.1016/j.eats.2018.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/08/2018] [Indexed: 02/03/2023] Open
Abstract
Accurate deployment of the femoral button on the lateral aspect of the lateral femoral condyle when using a suspensory fixation device for anterior cruciate ligament reconstruction is ideal. Direct visualization would be the most appropriate method of visualization in the lateral gutter. A previously described technique is performed with the knee in flexion. In this position, maneuverability of the arthroscope in the lateral gutter may be difficult in small knees because of tight lateral structures. We describe a simple technique in which visualization is performed with the knee in extension, which is especially useful in small knees.
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Affiliation(s)
| | | | | | - Thilak Samuel Jepegnanam
- Address correspondence to Thilak Samuel Jepegnanam, M.S.Orth., Department of Orthopaedics Unit 3, Christian Medical College, Vellore 632004, Tamilnadu, India.
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Ohnishi Y, Chang A, Utsunomiya H, Suzuki H, Nakamura E, Sakai A, Uchida S. Arthroscopic Technique to Reduce Suture Button Migration During Anterior Cruciate Ligament Reconstruction Procedure. Arthrosc Tech 2017; 6:e1927-e1931. [PMID: 29416980 PMCID: PMC5797844 DOI: 10.1016/j.eats.2017.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/11/2017] [Indexed: 02/03/2023] Open
Abstract
Suture button-based femoral cortical suspension constructs of anterior cruciate ligament grafts can facilitate a fast and secure fixation. However, there are several case reports showing button malpositioning resulting from the inability to visualize the "flipped" button. Many current surgical techniques do not allow direct visualization of EndoButtons (Smith & Nephew, Andover, MA) in their final position, making it difficult to ensure that both buttons are fully flipped and that there is no soft-tissue interposition between the button and femur. We describe an arthroscopic technique for making femoral tunnels through the outside-in method that reduces the migration of the EndoButton through a lateral femoral portal. This technique may assist surgeons in understanding how to deal with and potentially avoid EndoButton migration during anterior cruciate ligament reconstruction.
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Affiliation(s)
- Yasuo Ohnishi
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Angela Chang
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Hitoshi Suzuki
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Eiichiro Nakamura
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan,Address correspondence to Soshi Uchida, M.D., Ph.D., Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu, Kitakyushu, Fukuoka 808-0024, Japan.Department of Orthopaedic SurgeryWakamatsu Hospital for the University of Occupational and Environmental Health1-17-1 HamamachiWakamatsuKitakyushuFukuoka808-0024Japan
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15
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Anterior cruciate ligament reconstruction: MR imaging findings. Musculoskelet Surg 2017; 101:23-35. [PMID: 28197894 DOI: 10.1007/s12306-017-0460-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 01/13/2023]
Abstract
More than two million people tear their anterior cruciate ligament (ACL) each year, and ACL reconstruction occupies a significant proportion of everyday orthopedic practice, being one of the most commonly performed sports medicine surgical procedures. Patients with postoperative symptoms are frequently imaged to monitor ligament grafts and to identify complications. Given the number of patients undergoing ACL reconstruction, knowledge of the potential complications of this surgery is essential for radiologists. This article provides a review of imaging of ACL reconstruction procedures and the potential complications specific to this surgery.
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Akaoka Y, Tensho K, Shimodaira H, Aoki T, Takanashi S, Kato H, Saito N. Early Postoperative Intratunnel Migration of an EndoButton After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Report. JBJS Case Connect 2014; 4:e111. [PMID: 29252779 DOI: 10.2106/jbjs.cc.n.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CASE We report a rare case of early postoperative migration of an EndoButton following anatomic double-bundle anterior cruciate ligament reconstruction with use of the EndoButton for femoral fixation. Although secure fixation of the EndoButton was confirmed during the operation, one-week postoperative radiographs revealed an intratunnel displacement of the posterolateral EndoButton. We performed a reoperation and refixed the EndoButton to the surface of the femoral cortex; we also hooked and tied both ends of the sutures to make a knot in order to prevent remigration. CONCLUSION Orthopaedic surgeons should be aware that EndoButton displacement and migration could arise at an early postoperative stage.
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Affiliation(s)
- Yusuke Akaoka
- Departments of Orthopedic Surgery (Y.A., K.T., H.S., T.A., S.T., and H.K.) and Applied Physical Therapy (N.S.), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan. . . . . . .
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Sonnery-Cottet B, Rezende FC, Martins Neto A, Fayard JM, Thaunat M, Kader DF. Arthroscopically confirmed femoral button deployment. Arthrosc Tech 2014; 3:e309-12. [PMID: 25126492 PMCID: PMC4130137 DOI: 10.1016/j.eats.2014.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/08/2014] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means "one size fits all," thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
- Address correspondence to Bertrand Sonnery-Cottet, M.D., Centre Orthopédique Santy, 24 Avenue Paul Santy, F-69008, Lyon, France.
| | | | | | - Jean M. Fayard
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Deiary F. Kader
- City Campus East, Northumbria University, Newcastle upon Tyne, England
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