Fibular Collateral Ligament Reconstruction Graft Options: Clinical and Radiographic Outcomes of Autograft Versus Allograft

The Effect of Tibial Tunnel Drilling Technique on Retained Intra-Articular Bone Debris Following Anterior Cruciate Ligament Reconstruction

Purpose

To assess the effect of tibial tunnel drilling technique (retro-drilled bone socket vs full tibial tunnel) on the presence and grade of postoperative, intra-articular bone debris following primary hamstring anterior cruciate ligament (ACL) reconstruction.

Methods

This was a retrospective cohort study of primary hamstring autograft ACL reconstructions performed by 2 surgeons. Two blinded independent reviewers assessed the presence and length of retained intra-articular bone debris on the immediate postoperative lateral radiograph. Debris was graded according to a predefined 5-point ordinal grading system: grade 0 (no debris) to IV (severe debris). Results were analyzed according to the type of tibial tunnel; retro-drilled socket or full tibial tunnel using Kappa statistics and the Mann-Whitney U test.

Results

Sixty-five patients undergoing primary hamstring ACL were included (39 tibial socket: 26 full tibial tunnel). Bone debris was observed among the tibial socket technique in 29 of 39 instances (74.3%), compared with 14 of 26 (53.8%) instances for the full tibial tunnel technique (P = .09). Where there was measurable debris present, the tibial socket group had a mean length of bone debris of 13.7 ± 6.2 mm as compared with the full tibial tunnel, 10.0 ± 4.7 mm (P = .165). There were significant differences in bone debris gradings between the 2 treatment groups, with tibial sockets having an overall greater grade (P = .04).

Conclusions

A difference in the presence of, or length of, retained bone debris on the postoperative lateral radiograph was not demonstrated between the retro-drilled bone socket and full tibial tunnel techniques. However, when bone debris was present, greater grades of debris were seen in the retro-drilled socket group.

Level of Evidence

III, retrospective, comparative study.

Combined anterior cruciate and lateral collateral ligaments reconstruction with ipsilateral hamstring autograft: surgical technique

Different surgical techniques have been proposed to reconstruct combined anterior cruciate (ACL) and lateral collateral ligaments (LCL). Although these surgical techniques are reliable and reproducible, the number of autologous grafts needed for the reconstruction could be a limiting factor, especially when patients present with multi-ligament knee injuries and the posterior cruciate ligament is also torn. In addition, some of these techniques are not easy to master and have a steep learning curve. We present a surgical procedure that has been used over the last 18 years to reconstruct combined ACL and LCL injuries and has become a reproducible, feasible and time-efficient procedure to approach combined ACL and LCL injuries using an ipsilateral hamstring autograft.

Editorial Commentary: Autograft Beats Allograft for Most Knee Ligament Surgery

Knee ligament reconstruction can be performed with autograft or allograft. The use of an autograft has been shown to improve outcomes in primary anterior cruciate ligament reconstruction for young, active patients, and also in revision anterior cruciate ligament reconstruction surgery. A systematic review of posterior cruciate ligament reconstruction showed no difference in outcomes between autograft and allograft tissue. There is a paucity of data comparing autograft versus allograft for fibular collateral ligament and posterolateral corner reconstructions, alone or combined with other ligament surgery. Allograft advantages include no donor site morbidity and reduced operative time. Disadvantages include increased cost and higher failure rates in younger patients. Autograft tissue should be considered in younger, active patients whenever possible.