Intraarticular EndoButton displacement in anatomic anterior cruciate ligament double-bundle reconstruction: A case report

Complications following Suture Button Use for Femoral Graft Fixation in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Systematic Review

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.

In vitro comparison between cortical and cortico-cancellous femoral suspension devices for anterior cruciate ligament reconstruction: implications for mobilization

PURPOSE

To analyse the capability of cortical and cortical-cancellous suspension devices to provide a strong fixation in order to follow an aggressive early mobilization protocol.

METHODS

Anterior cruciate ligament (ACL) reconstruction was performed in vitro on 40 porcine femurs employing a high-strength braided cord as a graft. Four femoral suspension devices were analysed: the cortical suspension devices Endobutton and XO Button and the cortical-cancellous suspension devices Biosteon Cross-pin and Cross-pin ACL. Two kinds of biomechanical testing were carried out: static and post-fatigue failure strength tests. Stiffness, failure load, elongation at failure load, elongation after 20 cycles and elongation after 1,000 cycles were assessed. The bones were cut after testing to analyse the failure pattern.

RESULTS

All of the devices exceed 50 % of total elongation in the first 20 cycles of fatigue. In the static failure tests, there were significant differences (p < 0.05) in elongation to failure between the cortical-cancellous suspension devices Biosteon Cross-pin and Cross-pin ACL and the cortical suspension device Endobutton. No significant differences were found in the failure tests after 1,000 cycles of loading. The failure mode of the cortical devices comprised breakage of the cortical bone, accompanied by introduction of the device into the tunnel. The failure mode of the cortical-cancellous devices was pin breakage accompanied by tunnel enlargement.

CONCLUSION

The first cycles of mobilization are critical for elongation. This mobilization process does not significantly diminish the mechanical characteristics of the reconstructions. All the fixations support an intensive early mobilization protocol, with loads of over 500 N.

A Three-Dimensional Evaluation of EndoButton Displacement Direction After Anterior Cruciate Ligament Reconstruction in CT Image Using Tunnel Axis

The goal of this study was to propose a threedimensional evaluation of the EndoButton displacement direction after anterior cruciate ligament reconstruction in the multidetector-row computed tomography (MDCT) image by using the tunnel axis. The proposed method was applied experimentally to six subjects. The result of the simulated experiment revealed that the proposed method could analyze EndoButton displacement direction satisfactorily because the error was less than that of the MDCT image resolution. The clinical experiment results revealed displacement relative to the tunnel between time-zero and the followup point. We conclude that the proposed method can quantitatively evaluate the EndoButton displacement direction from the raw MDCT image after anterior cruciate ligament reconstruction; further, our findings suggest that the EndoButton was displaced relative to the tunnel between time-zero and the follow-up point.

An Automatic Three-Dimensional Evaluation of Screw Placement After Anterior Cruciate Ligament Reconstruction Using MDCT Images

A metallic interference screw, which is a fixation device used in anterior cruciate ligament (ACL) reconstruction, is important for fixing the grafts to the tibia. Loosening of fixation sometimes happens because the screw is displaced time passes, which results in instability of the knee. It is therefore important to analyze screw displacement highly accurately. The purpose of this study is to propose an evaluation of screw displacement in MDCT imaging of the knee after ACL reconstruction. Clinical experiments used 22 MDCT images that are not displaced in the clinical sense. Results of simulation experiments show that error was 0.14 mm, which was less thanMDCT image resolution. This study concluded that the proposed method useful in evaluating two MDCT images at different time points.

"Anatomic" anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data

PURPOSE

The aim of this systematic review was to evaluate studies published on anatomic double-bundle anterior cruciate ligament (ACL) reconstruction.

METHODS

A systematic electronic search was performed by use of the Medline and Embase databases. Studies that were published from January 1995 to April 2009 were included. The selection criteria were studies that reported on a surgical technique for "anatomic double-bundle ACL reconstruction" on skeletally mature living human subjects and were written in English. Data collected and analyzed included a variety of surgical data. Tables were created to provide an overview of surgical techniques for anatomic ACL reconstruction.

RESULTS

Seventy-four studies were included in this review. Some surgical factors were adequately reported in the majority of the articles: visualizing the native ACL insertion sites, placing the tunnels in the footprint, graft type, and fixation method. However; ACL insertion site measurement, femoral intercondylar notch measurement, individualization of surgery, and intraoperative/postoperative imaging were poorly reported. The most variety was seen in knee flexion angle during femoral tunnel drilling and tensioning pattern of the grafts.

CONCLUSIONS

For most surgical data, there was a gross under-reporting of specific operative technique data. We believe that the details of an "anatomic" operative technique are crucial for the valid interpretations of the outcomes. Thus we encourage authors to report their surgical technique in a specific and standardized fashion.

Arthroscopic double-bundle anterior cruciate ligament reconstruction using autogenous quadriceps tendon

Recently, the interest in anatomic anterior cruciate ligament (ACL) reconstruction with double-bundle technique has increased so as to reproduce the original load distribution and kinematics of the knee. We developed an arthroscopic double-bundle ACL reconstruction technique using autogenous quadriceps tendon with 2 split grafts and a patellar bone plug. The anteromedial bundle and posterolateral bundle of the ACL are replicated with each split graft of quadriceps tendon and fixed with biodegradable interference screws on the 2 femoral tunnels. The patellar bone plug of the quadriceps tendon is fixed with a biodegradable interference screw within the 1 tibial tunnel. We suggest that our technique using quadriceps tendon may be an alternative in arthroscopic double-bundle ACL reconstruction.