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Nie S, Zhou S, Huang W. Femoral fixation methods for hamstring graft in anterior cruciate ligament reconstruction: A network meta-analysis of controlled clinical trials. PLoS One 2022; 17:e0275097. [PMID: 36137116 PMCID: PMC9499312 DOI: 10.1371/journal.pone.0275097] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 09/11/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the clinical effectiveness of cortical button (CB), cross-pin (CP) and compression with interference screws (IS) fixation techniques in anterior cruciate ligament (ACL) reconstruction using hamstring graft. Methods Studies were systematically retrieved from PubMed, Embase, Cochrane Library and Web of Science up to May 20, 2021. Primary outcomes were KT-1000 assessment, International Knee Documentation Committee (IKDC) score A or B, Lachman’s test, pivot-shift test, visual analogue scale (VAS) score, Lysholm score, Tegner score, and Cincinnati Knee Score. Secondary outcomes included reconstruction failures and synovitis. League tables, rank probabilities and forest plots were drawn for efficacy comparison. Results Twenty-six controlled clinical trials (CCTs) with 1,824 patients undergoing ACL reconstruction with hamstring graft were included. No significant differences were found among CB, CP and IS fixation methods regarding the 10 outcomes. For KT-1000 assessment, IKDC score A or B, Lachman’s test, VAS score and pivot-shift test, CP had the greatest probability of becoming the best method, and IS may be the suboptimal method in 4 out of these 5 outcomes except pivot-shift test. Conclusions CP, CB and IS fixations have comparable clinical performance, while CP fixation is most likely to be the optimum fixation technique for hamstring graft in ACL reconstruction. Future larger-sample studies of high quality comparing these techniques in more clinical outcomes are required.
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Affiliation(s)
- Shixin Nie
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Shuqing Zhou
- Department of Orthopedics, The Centre Hospital of Jiangjin, Chongqing, China
| | - Wei Huang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
- * E-mail:
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Deng Z, Zheng Y, Deng Z, Lu C, Wu Y, Chen K, Fu Z, Zhang H, Lu W, Zhu W. Arthroscopic reconstruction of anterior cruciate ligaments with allograft: single-tunnel single-bundle versus single-tunnel double-bundle techniques. J Orthop Traumatol 2022; 23:26. [PMID: 35759061 PMCID: PMC9237191 DOI: 10.1186/s10195-022-00649-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 06/12/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To compare the clinical results of anterior cruciate ligament (ACL) reconstruction using the single-tunnel single-bundle (STSB) technique versus the single-tunnel double-bundle (STDB) technique. Methods This was a retrospective, single-center, single-surgeon study based on data collected from March 2012 to June 2013. According to our inclusion/exclusion criteria, a total of 78 patients (64 males, 14 females; mean age, 25.1 years) who underwent arthroscopic ACL reconstruction with anterior tibialis tendon allografts through either the STSB technique (36 cases) or the STDB technique (42 cases) in our department were recruited. The International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores were used to evaluate the subjective function of the knee joint during the postoperative follow-up. The Lachman test and pivot shift test were used to objectively assess the stability of the knee. Results The average follow-up duration was 24.9 ± 1.8 months in the STSB group and 24.6 ± 1.7 months in the STDB group (P > 0.05). Patients in both groups recovered to the preoperative sports level with few complications. The postoperative Lysholm score (86.1 ± 7.5 vs. 47.7 ± 9.0 in the STSB group; 87.0 ± 7.1 vs. 48.2 ± 8.3 in the STDB group), IKDC score (87.8 ± 7.2 vs. 49.3 ± 6.1 in the STSB group; 88.7 ± 6.6 vs. 49.8 ± 6.3 in the STDB group), Tegner score (6.5 ± 1.3 vs. 2.5 ± 1.3 in the STSB group; 6.6 ± 1.2 vs. 2.6 ± 1.2 in the STDB group), Lachman test positive rate (8.3% vs. 89.9% in the STSB group; 7.1% vs. 85.7% in the STDB group), and pivot shift test positive rate (27.8% vs. 63.9% in the STSB group; 7.1% vs. 69.0% in the STDB group) were significantly improved compared to the preoperative status in both groups (P < 0.05). However, no statistically significant difference was observed between the two groups at the final follow-up (P > 0.05), except for the pivot shift test positive rate in the STDB group versus the STSB group (7.1% vs. 27.8%, P < 0.05). Conclusions The STDB technique achieved a satisfactory clinical outcome with better rotational stability compared to the traditional STSB technique and therefore provided an effective option for ACL reconstruction. Level of evidence Case series, Level IV.
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Affiliation(s)
- Zhenhan Deng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China.,Guangxi University of Chinese Medicine, Nanning, 530200, Guangxi, China
| | - Yizi Zheng
- Guangxi University of Chinese Medicine, Nanning, 530200, Guangxi, China
| | - Zhiqin Deng
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China
| | - Changwei Lu
- Department of Spine and Joint Orthopedics, The People's Hospital of Hechi, Hechi, 547000, Guangxi, China
| | - Yihua Wu
- Department of Spine and Joint Orthopedics, The People's Hospital of Hechi, Hechi, 547000, Guangxi, China
| | - Kang Chen
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China
| | - Zicai Fu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China
| | - Hui Zhang
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China
| | - Wei Lu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China.,Guangxi University of Chinese Medicine, Nanning, 530200, Guangxi, China
| | - Weimin Zhu
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, Guangdong, China. .,Guangxi University of Chinese Medicine, Nanning, 530200, Guangxi, China.
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Sinha S, Naik AK, Kumar A, Jacob T, Kar S. Analysis of modified double-bundle anterior cruciate ligament reconstruction with implantless fixation on tibial side. Chin J Traumatol 2020; 23:341-345. [PMID: 32417042 PMCID: PMC7718536 DOI: 10.1016/j.cjtee.2020.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/08/2019] [Accepted: 12/10/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To avoid potential problems of double-bundle anterior cruciate ligament reconstruction (ACLR), various modifications have been reported. This study analyzed a novel technique of modified double-bundle (MDB) ACLR without implant on tibial side in comparison to single-bundle (SB) ACLR. METHODS Eighty cases of isolated anterior cruciate ligament tear (40 each in SB group or MDB group) were included. SB ACLR was performed by outside in technique with quadrupled hamstring graft fixed with interference screws. In MDB group, ACLR harvested tendons were looped over each other at the center and free ends whipstitched. Femoral tunnel was created by outside in technique. Anteromedial tibial tunnel was created with tibial guide at 55°. The anatomic posterolateral aiming guide (Smith-Nephew) was used to create posterolateral tunnel. With the help of shuttle sutures, the free end of gracillis was passed through posterolateral tunnel to femoral tunnel followed by semitendinosus graft through anteromedial tunnel to femoral tunnel. On tibial side the graft was looped over bone-bridge between external apertures of anteromedial and posterolateral tunnel. Graft was fixed with interference screw on femoral side in 10° knee flexion. International Knee Documentation Committee (IKDC), Tegner score, Pivot shift and knee laxity test (KLT, Karl-Storz) were recorded pre- and post-surgery. At one year magnetic resonance imaging (MRI) was done. Statistical analysis was done by SPSS software. RESULTS Mean preoperative KLT reading of (10.00 ± 1.17) mm in MDB group improved to (4.10 ± 0.56) mm and in SB group it improved from (10.00 ± 0.91) mm to (4.80 ± 0.46) mm. The mean preoperative IKDC score in MDB group improved from (49.49 ± 8.00) to (92.5 ± 1.5) at one year and that in SB group improved from (52.5 ± 6.9) to (88.4 ± 2.6). At one-year 92.5% cases in MDB group achieved their preinjury Tegner activity level as compared to 60% in SB group. The improvement in IKDC, KLT and Tegner scale of MDB group was superior to SB group. MRI confirmed graft integrity at one year and clinically at 2 years. CONCLUSION MDB ACLR has shown better outcome than SB ACLR. It is a simple technique that does not require fixation on tibial side and resultant graft is close to native ACL.
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Affiliation(s)
- Skand Sinha
- Sports Injury Centre, Safdarjung & VMMC, New Delhi 110029, India,Corresponding author.
| | - Ananta K. Naik
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi 110001, India
| | - Appan Kumar
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi 110001, India
| | - Tista Jacob
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi 110001, India
| | - Santanu Kar
- Department of Orthopaedics, PGIMER & Dr RML Hospital, New Delhi 110001, India
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Li W, Song Y, Song B, Yang R, Xing T, Chen Z, Zhang Z, Ouyang Y. Comparison of anterior cruciate ligament reconstruction methods between reverse "Y" plasty reconstruction and traditional single-bundle technique-A cadaveric study. J Orthop Translat 2018; 14:1-7. [PMID: 30123736 PMCID: PMC6093085 DOI: 10.1016/j.jot.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 12/04/2022] Open
Abstract
Background In 2009, a reverse “Y” plasty anterior cruciate ligament (ACL) reconstruction technique was proposed, with double-tibial tunnel and single-femoral tunnel, and the result obtained proved that the reverse “Y” plasty technique was satisfactory. This cadaveric study was designed to compare the reverse “Y” plasty reconstruction method with the conventional single-bundle technique for the first time. Methods In this study, 30 cadaveric knees were used and were randomly divided into five groups with six knees each. Six cadaveric knees with intact ACL were treated as the control group, and another six knees with ruptured ACL were treated as the rupture group. In group A, the single-bundle technique was used. In groups B and C, reverse “Y” plasty technique was used, and the grafts were fixed with absorbable biointerference screws in tibiae and absorbable biointerference screws (Group B) or Endobutton (Group C) in femora. Five groups were tested with an MTS material testing machine (MTS-858) by the use of a cyclic loading of 134 N at 15°, 30°, 60° and 90° of knee flexion and a combined 7-Nm valgus torque and 5-Nm internal tibial rotation torque at 15°, 30°, 45° and 60° of knee flexion. Results Both single-bundle and reverse “Y” plasty groups demonstrated similar anterior–posterior stability compared with the control group, whereas the single-bundle group showed inferior rotational stability tested at 30° and 45° of knee flexion than the reverse “Y” plasty group and control group. These two different fixation methods at the femoral site (Group B and C) showed no difference in anterior–posterior and rotational stability. Conclusions The new reverse “Y” plasty ACL reconstruction method may restore normal knee stability, especially rotational stability, better than single-bundle reconstruction. The translational potential of this article This study provides strong support for the new reverse “Y” plasty ACL reconstruction technique and is expected to propose a new surgical approach with good biomechanical features.
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Affiliation(s)
- Weiping Li
- Sports Medicine Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Yang Song
- Department of Orthopedics, Shunde Hospital, Southern Medical University, Guangzhou, PR China
| | - Bin Song
- Sports Medicine Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Rui Yang
- Sports Medicine Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Tong Xing
- Sports Medicine Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Zhong Chen
- Sports Medicine Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Zhengzheng Zhang
- Sports Medicine Department, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, PR China
| | - Yi Ouyang
- Department of Orthopedics, Shunde Hospital, Southern Medical University, Guangzhou, PR China
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Eysturoy NH, Nissen KA, Nielsen T, Lind M. The Influence of Graft Fixation Methods on Revision Rates After Primary Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2018; 46:524-530. [PMID: 29337596 DOI: 10.1177/0363546517748924] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The method of graft fixation in primary anterior cruciate ligament (ACL) reconstruction is important for initial stability of the graft. Poor graft fixation can result in failure of the reconstruction. The effect of ACL graft fixation principles and fixation implant combinations on the risk of revision after ACL reconstruction is not well understood. PURPOSE The study aimed to compare the risk of revision among 4 categories of femoral fixation divided by their principle of function using a hamstring tendon (HT) graft only. Furthermore, this study aimed to compare the risk of revision among the most frequently used combinations (tibia and femur) of graft fixation implants in a national patient cohort. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors divided the femoral fixation constructs into 4 categories by their principle of function: cortical suspensory fixation, adjustable cortical suspensory fixation, intratunnel transfixation, and interference screw (aperture) fixation. Data on revision rates and graft fixation methods were extracted from the Danish ACL Reconstruction Registry. The study included patients who underwent primary ACL reconstruction with either an HT or patellar tendon (PT) graft and were followed up at 2 to 10 years. Revision rates at 2-year and full follow-up were extracted for the category of graft fixation in the femur as well as for the most common implant combinations (those involving >175 patients). Patients with infrequently used fixation devices were excluded from this analysis. The HT group included 14 frequently used combinations (n > 175), and there were 2 such combinations in the PT group. A total of 13,200 ACL reconstructions were included in the study. For ACL reconstruction with an HT graft, there were 4680 with cortical suspensory fixation, 577 with adjustable cortical suspensory fixation, 5921 with intratunnel transfixation, and 617 with interference screw fixation. There were 1405 ACL reconstructions with a PT graft. RESULTS When only comparing primary ACL reconstructions using an HT graft, cortical suspensory fixation exhibited a significantly higher risk of revision at 2-year follow-up than the other categories of femoral fixation (hazard ratio [HR], 1.24 [95% CI, 1.07-1.44]; P < .05). Intratunnel transfixation exhibited a significantly lower risk of revision (HR, 0.83 [95% CI, 0.73-0.94]; P < .05). Comparing the most frequently used femoral/tibial fixation implant combinations with the mean risk of revision, Endobutton/Intrafix and Endobutton/Biosure PEEK for HT grafts exhibited an increased risk of revision, with an relative risk (RR) of 1.36 (95% CI, 1.03-1.81; P < .05) and 1.55 (95% CI, 1.15-2.09; P < .05), respectively. The Atlantech metal screw/metal screw and Softsilk/Softsilk combinations (both for PT grafts) exhibited a significantly decreased risk of revision, with an RR of 0.41 (95% CI, 0.18-0.91; P < .05) and 0.36 (95% CI, 0.15-0.87; P < .05), respectively. CONCLUSION When comparing ACL graft fixation methods in the 4 categories using an HT graft, cortical suspensory fixation was found to have a significantly increased risk of revision, while intratunnel transfixation exhibited a lower risk of revision. Both Endobutton/Intrafix and Endobutton/Biosure PEEK implant combinations exhibited a significantly higher risk of revision. For PT grafts, Atlantech metal screw/metal screw and Softsilk/Softsilk exhibited a significantly lower risk of revision.
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Affiliation(s)
- Niclas H Eysturoy
- Division of Sports Traumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Kåre Amtoft Nissen
- Division of Sports Traumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Torsten Nielsen
- Division of Sports Traumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
| | - Martin Lind
- Division of Sports Traumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus, Denmark
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Watson JN, McQueen P, Kim W, Hutchinson MR. Bioabsorbable interference screw failure in anterior cruciate ligament reconstruction: A case series and review of the literature. Knee 2015; 22:256-61. [PMID: 25795545 DOI: 10.1016/j.knee.2015.02.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/06/2015] [Accepted: 02/24/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND To report a case series of failures of bioabsorbable interference screws with possible identification of a novel failure mechanism. METHODS A retrospective review of ACL reconstructions by the senior author utilizing BioComposite™ Interference Screws (Arthrex, Inc., Naples, FL) was performed. Complications related to screw placement, including fracture, breakage or bending were examined. Our rate and methods of failure were compared to those quoted in the current literature. RESULTS Eighty-seven patients of average age 23.8 years met inclusion criteria. There were eight screw failures in six patients, with femoral failure in seven and tibial failure in one. The femoral screw fractured halfway between the tip and head in five, while the head of the screw broke in one and the screw bent in another. In the case of tibial interference screw fracture, failure occurred halfway between the tip and head. The insertion device that was used was replaced after recognition of material deformation and considered a potential contributor to the breakage risk as no further screw failures have occurred since. CONCLUSIONS We demonstrate a unique failure mechanism of bio-absorbable interference screws. In each case, the reconstruction was salvaged. Regular inspection of materials and implants can ensure optimal outcomes and decrease complications intra-operatively.
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Affiliation(s)
- Jonathan N Watson
- University of Illinois at Chicago Department of Orthopaedic Surgery, Chicago, IL, United States.
| | - Peter McQueen
- University of Illinois at Chicago Department of Orthopaedic Surgery, Chicago, IL, United States.
| | - Walter Kim
- University of Illinois at Chicago Department of Orthopaedic Surgery, Chicago, IL, United States.
| | - Mark R Hutchinson
- University of Illinois at Chicago Department of Orthopaedic Surgery, Chicago, IL, United States.
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Ratio of T Helper to Regulatory T Cells in Synovial Fluid and Postoperative Joint Laxity After Allograft Anterior Cruciate Ligament Reconstruction. Transplantation 2012; 94:1160-6. [DOI: 10.1097/tp.0b013e31826dddeb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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