Reconstruction of the anterior cruciate ligament by means of an anteromedial portal and femoral fixation using Rigidfix

Safe femoral condyle range for the reverse Rigidfix femoral fixation device in anterior cruciate ligament reconstruction

Background

To determine the characteristics of cross-pin protrusion in patients treated with the reverse Rigidfix femoral fixation device for femoral tunnel preparation through the anteromedial portal in Arthroscopic anterior cruciate ligament reconstruction (ACLR), analyse the reasons for this outcome, and identify safety hazards of this surgical technique for improvement.

Methods

A retrospective analysis of patients who underwent ACLR using this technology at our hospital in 2018 was conducted. Patients with and without cross-pin protrusion were included in the protrusion positive and negative groups, respectively. The sex, age and imaging characteristics of the patients with cross-pin protrusion were identified, and the reasons for cross-pin protrusion were analysed.

Results

There were 64 and 212 patients in the protrusion positive and negative groups, respectively. The proportion of cross-pin protrusion cases was 23.19% (64/276). There was a significant difference in the ratio of males to females (P < 0.001, χ2 = 185.184), the mediolateral femoral condyle diameter (protrusion positive group, 70.59 ± 2.51 mm; protrusion negative group, 82.65 ± 4.16 mm; P < 0.001, t = 28.424), and the anteroposterior diameter of the lateral femoral condyle (protrusion positive group, 58.34 ± 2.89 mm; protrusion negative group, 66.38 ± 3.53 mm; P < 0.001, t = 16.615). The cross-pins did not penetrate the lateral femoral condyle cortex in patients with a mediolateral femoral condyle diameter ≥ 76 mm, but the cross-pins definitely penetrated the cortex when the diameter was ≤ 70 mm. The cross-pins did not penetrate when the anteroposterior lateral femoral condyle diameter was ≥ 66 mm, but the cross-pins definitely penetrated it when the diameter was ≤ 59 mm.

Conclusion

The patients with cross-pin protrusion after reverse Rigidfix femoral fixation treatment to prepare the femoral tunnel through the anteromedial portal in ACLR were mainly females with small femoral condyles. For patients with a mediolateral femoral condyle diameter ≥ 76 mm and an anteroposterior lateral femoral condyle diameter ≥ 66 mm, there is no risk of cross-pin protrusion, so this technique can be used with confidence.

Levels of evidence

III.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05250-8.

Transportal Anterior Cruciate Ligament Reconstruction with Quadrupled Hamstring Tendon Graft: A Prospective Outcome Study

BACKGROUND

Anterior cruciate ligament (ACL) reconstruction has been one of the most commonly performed procedures throughout the world. Unsatisfactory outcome with conventional ACL reconstruction has been attributed to nonanatomic graft placement. Researchers have advised placing the graft in the native footprint of ACL to avoid nonanatomic graft placement. The goal of this study was to analyze the outcome of anatomic single bundle ACL reconstruction using transportal technique.

MATERIALS AND METHODS

This was a prospective outcome study conducted on 85 consecutive patients of ACL reconstruction of which 62 patients met inclusion and exclusion criteria and were analyzed for final results. All the patients underwent ACL reconstruction by quadrupled hamstring tendon graft using transportal technique and the accessory anteromedial (AAM) portal for femoral tunnel creation. The graft was fixed with endobutton on femoral side and bioabsorbable screw on the tibial side. Patients were evaluated for range of motion, International Knee Documentation Committee (IKDC) score, and Lysholm scores at a minimum followup period of 2 years. The mean pre- and postoperative scores were compared using Wilcoxon signed-rank test.

RESULTS

The mean Lysholm and IKDC scores improved significantly (P < 0.0001) from preoperative value. According to IKDC score, 90.3% (n = 56) were either normal or near normal at final followup. According to Lysholm score, 75.8% of patients had excellent and 13.3% had good results. Preoperatively, pivot shift was present in 85.5% (n = 53) of patients which reduced to 4.8% (n = 3) postoperatively. Infection and knee stiffness occurred in two patients, and femoral tunnel blowout and graft re-rupture occurred in one patient each.

CONCLUSION

Anatomic ACL reconstruction by AAM portal is a reproducible technique which gives good clinical outcome at short-term followup.