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Chalidis B, Pitsilos C, Pavlopoulos C, Papadopoulos P, Gigis I, Papadopoulos P. Comparison of Cross-Pin Versus Cortical Button Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft: A Long-Term Clinical Study and Review of the Literature. Cureus 2024; 16:e57928. [PMID: 38725740 PMCID: PMC11081715 DOI: 10.7759/cureus.57928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) is a common operative procedure and many options regarding the type of the selected graft and fixation technique have been described to date. Although many studies have addressed the issue of the optimal femoral fixation device during ACLR with a hamstring tendon (HT) autograft, no clear evidence to indicate one technique over another has been found. Objective The purpose of this study was to compare the long-term postoperative outcomes and complication rates between transfemoral Cross-pin (CP) and Endobutton-Cortical Button (CB) fixation techniques in patients undergoing ACLR with an HT autograft. Methods One hundred and seven consecutive patients underwent ACLR by using a quadruple HT autograft that was stabilized with either a CP (CP Group: 52 patients) or a CB (CB Group: 55 patients) fixation technique. The Lachman test (LT), the Pivot-shift test (PST), the side-to-side difference in anterior translation of the tibia, the International Knee Documentation Committee (IKDC), and the Lysholm knee scoring systems were evaluated before surgery and during long-term follow up. The femoral and tibial tunnel diameter was measured in the anteroposterior (AP) and lateral radiographs after surgery and at the final follow-up. A review of the literature was also carried out to identify any differences between both techniques. Results Study groups were comparable in terms of patient demographics. The mean follow-up was 10.4 ± 1.3 and 10.6 ± 1.3 years in the CP and CB Groups, respectively (p = 0.47). In the CP Group, improvements after surgery in LT and PST from grade 2 (n=34) or 3 (n=18) to grade 0 (n = 41) or 1 (n = 11) and from grade 2 (n=36) or 3 (n = 16) to grade 0 (n = 44) or 1 (n = 8), respectively, were observed. In the CB Group, similar improvements in LT and PST scores from grade 2 (n = 40) or 3 (n = 15) to grade 0 (n = 46) or 1 (n = 9) and from grade 2 (n = 41) or 3 (n = 14) to grade 0 (n = 47) or 1 (n = 8), respectively, were observed. However, no differences between the groups (p = 0.53 for LT and p = 0.90 for PST) were noted. The mean Lysholm scores were 89.7 ± 6.8 and 90.2 ± 7.2 in the CP and CB groups, respectively (p = 0.59). Side-to-side difference improved from 9.1 ± 2.8 to 1.7 ± 1.5 mm and from 8.6 ± 2.5 to 1.6 ± 1.4 mm in the CP and CB groups, respectively (p = 0.89 between groups). According to IKDC grades, 92.1% and 91.4% of knees in the CP and CB groups, respectively were reported to be Grade A (Normal) or B (Nearly Normal) with a p = 0.7. Femoral and tibial tunnel widening was found in the last follow-up in both groups. However, there was no difference in the degree of tunnel widening among the two techniques. With respect to LT, PST, anterior drawer test, and IKDC score, none of the 15 published comparative studies demonstrated any significant differences between the two techniques and only one study detected a difference regarding the Lysholm score in favor of CP fixation. Conclusion In the long term, both CB and CP femoral stabilization techniques were shown to be associated with similar functional outcomes and low complication rates. Further large multicenter random clinical trials are still required to identify the most effective method of femoral fixation for HT autograft during ACLR surgery.
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Affiliation(s)
- Byron Chalidis
- 1st Orthopaedic Department, Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Charalampos Pitsilos
- 2nd Orthopaedic Department, Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Charalampos Pavlopoulos
- 2nd Orthopaedic Department, Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Polychronis Papadopoulos
- 2nd Orthopaedic Department, Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Ioannis Gigis
- 2nd Orthopaedic Department, Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Periklis Papadopoulos
- 2nd Orthopaedic Department, Gennimatas Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Coppola C, Krost S, Runer A, Raas C, Glodny B, Mayr R. PEEK Interference Screws Show Significant Tunnel Enlargement After ACL Reconstruction and is Comparable to Adjustable-Length Loop Cortical Button Fixation. Indian J Orthop 2024; 58:40-47. [PMID: 38161404 PMCID: PMC10754774 DOI: 10.1007/s43465-023-01029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/19/2023] [Indexed: 01/03/2024]
Abstract
Background It is unclear whether the use of polyetheretherketone (PEEK) interference screws for anterior cruciate ligament (ACL) reconstruction leads to postoperative tunnel enlargement. Femoral tunnel enlargement was further compared with adjustable-length loop cortical fixation. Methods Eighteen patients with ACL reconstruction using hamstring grafts were retrospectively divided into two groups. Eleven patients were treated with the ACL reconstruction technique using a PEEK interference screw for femoral graft fixation. Seven patients received adjustable-length loop cortical buttons for femoral fixation. Tibial ACL graft fixation was performed using PEEK interference screws. Tunnel volume changes were assessed using computed tomography (CT) scans performed after surgery (100%) and after 1 year. The maximal tunnel diameter was measured. Results The group with femoral screw fixation showed a mean tunnel volume change of 108.15 ± 13.7% on the tibial side and 124.07 ± 25.38% on the femoral side. The group with femoral button fixation showed a tunnel volume change of 111.12 ± 12.72% on the tibial side and 130.96 ± 21.71% on the femoral side. The differences in femoral tunnel volume changes were not significant (P = 0.562). Femoral tunnels with PEEK screw fixation showed significantly larger diameter after 12 months in comparison with button fixation (13.02 ± 1.43 mm vs. 10.46 ± 1.29 mm, P < 0.001). Conclusions PEEK interference screws were associated with significant tibial and femoral tunnel enlargement. Femoral tunnel enlargement was comparable between PEEK interference screws and button fixation. Final femoral tunnel diameter was significantly larger with PEEK screw fixation in comparison to button fixation.
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Affiliation(s)
- Christian Coppola
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Krost
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Armin Runer
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Christoph Raas
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Raul Mayr
- Department of Orthopaedics and Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria
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Saad L, Grimard G, Nault ML. Complication rates following all-epiphyseal ACL reconstructions in skeletally immature patients: A retrospective case series study. Medicine (Baltimore) 2021; 100:e27959. [PMID: 34964784 PMCID: PMC8615306 DOI: 10.1097/md.0000000000027959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/22/2021] [Indexed: 01/05/2023] Open
Abstract
The aim was to evaluate the safety of a physeal-sparing anterior cruciate ligament reconstruction technique (ACLR), performed with Orthopediatrics (Warsaw, IN) equipment, by assessing complications.Skeletally immature patients who underwent all-epiphyseal ACLR between 2015 and 2017 with postoperative follow-up were included in this retrospective study. Complications, demographic, clinical, surgical, and imaging data was retrieved from an urban tertiary pediatric hospital database. Physeal status, limb-length discrepancies (LLD), and angular deformities were assessed on preoperative and postoperative radiographs, growth disturbances were reported, and initial and follow-up diameters of tunnels were compared.Nineteen ACLRs were included from 18 patients, 4 females and 14 males, with bone age at surgery of 13.3 ± 1.0 years. At a mean follow-up of 19.2 ± 10.1 months, there were no symptomatic growth disorders requiring intervention. There were: 2 (11.1%) unilateral early physeal closures, 2 (10.5%) new angular deformities (5°-10°), 4 (22.2%) LLD (1-2 cm), 1 (5.6%) contralateral ACLR, 1 (5.6%) femoral screw removal, 2 (10.5%) graft ruptures, and 1 meniscal tear (5.3%). Mean tunnel widening was 1.7 mm and 1.5 mm on the femoral and tibial side, respectively, and no massive osteolysis was recorded at the polyetheretherketone implant site.The complication rates were comparable to those in similar studies, with no growth-related complications at 19.2 months.
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Affiliation(s)
- Lydia Saad
- CHU Sainte-Justine, 3185 Chemin de la Côte Ste-Catherine, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Guy Grimard
- CHU Sainte-Justine, 3185 Chemin de la Côte Ste-Catherine, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, 3185 Chemin de la Côte Ste-Catherine, Montréal, Québec, Canada
- Université de Montréal, Montréal, Québec, Canada
- Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
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Panagopoulos A, Mylonas D, Kouzelis A, Zampakis P, Kraniotis P, Lakoumentas J, Gliatis J. No Difference in Outcomes Between Suspensory (Fixed-Loop Cortical Button) Versus Expandable Anteromedial Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Autologous Hamstring Tendons: A Prospective, Randomized, Controlled Study in Male Patients. Arthrosc Sports Med Rehabil 2021; 3:e1155-e1163. [PMID: 34430896 PMCID: PMC8365223 DOI: 10.1016/j.asmr.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To compare anterior cruciate ligament (ACL) autograft reconstruction using fixed-looped suspensory versus expandable femoral fixation through the anteromedial portal. Methods After we performed prospective power analysis and obtained institutional review board, 70 patients with ACL rupture were block randomized to the expandable or suspensory femoral fixation group (35 in each group). All patients received autologous hamstring autograft through the anteromedial portal and fixed with a sheath-screw system in the tibia. The primary outcome measures were anteroposterior knee stability at 2 years’ follow-up measured using the KT-1000 arthrometer and the degree of femoral and tibial tunnels’ widening measured by the use of computed tomography imaging performed immediately postoperative and 12 months postsurgery. Secondary outcome measures included pain score on a visual analog scale, the subjective International Knee Documentation Committee 2000 assessment form, the Lysholm score, and the Tegner activity scale at 3, 6, 12, and 24 months. Results Twenty-four patients were excluded from further analysis, leaving a total of 48 patients (24 in each group) for the final evaluation. The anteroposterior knee stability (KT-1000) showed no difference between groups at 24 months’ follow-up (P = .31). The percentile widening (%) of femoral and tibial tunnel at 1-year follow-up showed no difference also, except for greater values at the tibial coronal point T2 (P = .065) and tibial sagittal point T1 (P = .033) in the group of cortical buttons. Secondary clinical outcomes showed no statistical differences between groups at 3, 6, 12, and 24 months’ postoperatively. Numerical pain scale (visual analog scale) was similar in both groups except for postoperative day 7, where the AperFix group showed better results (P = .014). There were no major intraoperative and late postoperative complications in any of the groups. Conclusions Our results showed no significant differences in knee anteroposterior stability, tunnel enlargement or other clinical outcomes comparing expandable versus cortical button fixation in anteromedial hamstrings ACL reconstruction. Level of Evidence Level II, randomized controlled trial.
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Affiliation(s)
- Andreas Panagopoulos
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Dimitris Mylonas
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Antonis Kouzelis
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
| | - Petros Zampakis
- Department of Radiology, Patras University Hospital Greece, Patras, Greece
| | - Pantelis Kraniotis
- Department of Radiology, Patras University Hospital Greece, Patras, Greece
| | - John Lakoumentas
- Department of Medical Physics, School of Medicine, University of Patras, Patras, Greece
| | - John Gliatis
- Department of Sports Medicine, Patras University Hospital Greece, Patras, Greece
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Fang CH, Li M, Zhang YF, Liu H. Extra-articular migration of PEEK interference screw after anterior cruciate ligament reconstruction: a report of two cases. BMC Musculoskelet Disord 2021; 22:498. [PMID: 34051767 PMCID: PMC8164745 DOI: 10.1186/s12891-021-04387-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/19/2021] [Indexed: 11/27/2022] Open
Abstract
Background The interference screw is the most popular device that fixes the graft for anterior cruciate ligament reconstruction, reducing the incidence of windshield effect and bungee effect. For the screw, either metallic, “bioresorbable,” or polyetheretherketone (PEEK) material is available. PEEK is popular and extensively used due to its stability, biocompatibility, radiolucency, and elastic modulus. Rare relevant complications were reported, but here, we report two cases of extra-articular migrations of PEEK interference screw from the tibial tunnel after anterior cruciate reconstruction. Case report An 18-year-old boy and a 56-year-old woman underwent anterior cruciate ligament reconstruction using a PEEK interference screw to fix the graft in the tibial tunnel. They suffered from screw extrusion from the tibial tunnel after 40 days and six months, respectively, with an incision rupture or palpable subcutaneous mass. They underwent a second operation and recovered well. Conclusions The exact incidence of extra-articular migrations of PEEK interference screws is unknown, but it seems to be quite low; despite this and its uncertain cause, the negative effects caused by the PEEK material need to be considered.
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Affiliation(s)
- Chao-Hua Fang
- Department of Joint Surgery, Ningbo No.6 Hospital, No.1059 Zhongshan road, Yinzhou District, Zhejiang, 315000, Ningbo, People's Republic of China.,School of Biomedical Engineering, Shanghai Jiao Tong University, No.1954 Huashan Road, Xuhui District, 200240, Shanghai, People's Republic of China
| | - Ming Li
- Department of Joint Surgery, Ningbo No.6 Hospital, No.1059 Zhongshan road, Yinzhou District, Zhejiang, 315000, Ningbo, People's Republic of China
| | - Yun-Feng Zhang
- Department of Joint Surgery, Ningbo No.6 Hospital, No.1059 Zhongshan road, Yinzhou District, Zhejiang, 315000, Ningbo, People's Republic of China
| | - Hua Liu
- Department of Joint Surgery, Ningbo No.6 Hospital, No.1059 Zhongshan road, Yinzhou District, Zhejiang, 315000, Ningbo, People's Republic of China.
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Lee DH, Son DW, Seo YR, Lee IG. Comparison of femoral tunnel widening after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral cross-pin fixation: a systematic review and meta-analysis. Knee Surg Relat Res 2020; 32:11. [PMID: 32660647 PMCID: PMC7219213 DOI: 10.1186/s43019-020-0028-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/02/2020] [Indexed: 03/27/2023] Open
Abstract
Background The aim was to compare tunnel widening of autogenous hamstring anterior cruciate ligament reconstruction (ACLR) using cortical button versus cross-pin femoral fixation. Methods The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from inception to 11 April 2019. The study included all levels of evidence in studies that reported femoral tunnel widening and compared cortical button and cross-pin femoral fixation for ACLR. Results Six studies were included, covering a total of 344 knees. Using transtibial techniques for ACLR, the mean absolute amount of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross-pin fixation (−0.30 mm; 95% confidence interval (CI) −0.56,−0.05 mm; p= 0.02). Using the transtibial technique, the mean relative percentage of femoral tunnel widening was significantly greater with cortical button fixation than with transfemoral cross pin fixation (−5.73%; 95% CI −10.32, −1.14% ; p= 0.01). Conclusion The present meta-analysis revealed greater widening of the femoral tunnel when using cortical button fixation for hamstring ACLR via the transtibial technique than when using transfemoral cross-pin fixation.
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Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Wook Son
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
| | - Yi-Rak Seo
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - In-Gyu Lee
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
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Kim SH, Yang SH, Rhee SM, Lee KJ, Kim HS, Oh JH. The formation of perianchor fluid associated with various suture anchors used in rotator cuff repair. Bone Joint J 2019; 101-B:1506-1511. [DOI: 10.1302/0301-620x.101b12.bjj-2019-0462.r2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to compare the osseous reactions elicited by all-suture, polyetheretherketone (PEEK), and two different biodegradable anchors used during rotator cuff repair. Patients and Methods Transosseous-equivalent rotator cuff repair was performed in 73 patients. The patients were divided into two groups, in both of which two different medial-row anchors were used. In group 1, anchor A comprised 30% β-tricalcium phosphate (TCP) + 70% fast-absorbing poly lactic-co-glycolic acid copolymer (85% polylactic acid enantiomers + 15% polyglycolic acid) and anchor B comprised all-sutures. In group 2, anchor C comprised 23% micro β-TCP + 77% polylactic acid enantiomers and anchor D comprised PEEK polymer. There were 37 patients in group 1 and 36 patients in group 2. The presence and severity of fluid collection around anchors and healing of the rotator cuff were assessed using MRI scans, approximately one year postoperatively. The severity of the collection was graded as 0 (no perianchor fluid signal), 1 (minimal perianchor fluid), 2 (local collection of fluid), 3 (fluid collection around the whole length of the anchor but of a diameter less than twice the anchor diameter), or 4 (fluid collection around the whole length of the anchor and of a diameter greater than twice the anchor diameter). Results A perianchor fluid signal was seen in three patients (8.1%) with anchor A, four (10.8%) with anchor B, 15 (41.7%) with anchor C, and 15 (41.7%) with anchor D. The severity of the collection around anchor was grade 2:1:0:0 for anchor A, grade 2:2:0:0 for anchor B, grade 12:2:0:1 for anchor C, and grade 11:3:0:1 for anchor D (grade 1:2:3:4, respectively). The prevalence and severity of fluid formation was not significantly different between anchors A and B, and anchors C and D. However, on intergroup analysis, there were significant differences for the prevalence and severity of fluid formation between anchors in group 1 and group 2. The prevalence of failure to heal was not significant in group 1 (seven, 18.9%) or group 2 (nine, 25.0%). There was no relationship between the presence of perianchor fluid and each type of anchor, and the integrity of the rotator cuff repair, in either group. Conclusion Despite the nonabsorbable nature of all-suture and PEEK anchors, all-suture anchors produced less osseous reaction after rotator cuff repair. In deciding which kind of anchor to use, consideration should be given not only to the strength of the initial fixation, but also to the postoperative biological reaction. Cite this article: Bone Joint J 2019;101-B:1506–1511
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Affiliation(s)
- Sae H. Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Seok H. Yang
- Department of Orthopaedic Surgery, KS Hospital, Seongnam, South Korea
| | - Sung-Min Rhee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang J. Lee
- Department of Orthopaedic Surgery, Sun Orthopaedic Hospital, Seongnam, South Korea
| | - Hyong S. Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Joo H. Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
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Patel NA, Choi JH, Wang D. Tibial Fixation Techniques for Soft-Tissue Grafts in Anterior Cruciate Ligament Reconstruction. JBJS Rev 2019; 7:e7. [PMID: 31880625 DOI: 10.2106/jbjs.rvw.19.00047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nilay A Patel
- Department of Orthopaedic Surgery, University of California Irvine, Orange, California
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Liu Y, Rath B, Tingart M, Eschweiler J. Role of implants surface modification in osseointegration: A systematic review. J Biomed Mater Res A 2019; 108:470-484. [DOI: 10.1002/jbm.a.36829] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/23/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Yu Liu
- Department of Orthopaedic Surgery RWTH Aachen University Clinic Aachen Germany
| | - Björn Rath
- Department of Orthopaedic Surgery RWTH Aachen University Clinic Aachen Germany
| | - Markus Tingart
- Department of Orthopaedic Surgery RWTH Aachen University Clinic Aachen Germany
| | - Jörg Eschweiler
- Department of Orthopaedic Surgery RWTH Aachen University Clinic Aachen Germany
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Shumborski S, Heath E, Salmon LJ, Roe JP, Linklater JP, Facek M, Pinczewski LA. A Randomized Controlled Trial of PEEK Versus Titanium Interference Screws for Anterior Cruciate Ligament Reconstruction With 2-Year Follow-up. Am J Sports Med 2019; 47:2386-2393. [PMID: 31306589 DOI: 10.1177/0363546519861530] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Graft fixation with interference screws for anterior cruciate ligament (ACL) reconstruction is a highly successful technique. Polyether ether ketone (PEEK) is a novel thermoplastic polymer with high biocompatibility and mechanical properties that mimic native bone, and it can be imaged on computed tomography or magnetic resonance imaging (MRI) without signal flare. PURPOSE To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel technique was employed to measure tunnel volumes. RESULTS There were no significant differences in graft rerupture rate, contralateral ACL rupture rate, subjective outcomes, or objective outcomes. In the titanium and PEEK groups, MRI demonstrated high overall rates of graft integration (96%-100% and 90%-93%, respectively) and ligamentization (89% and 84%) and low rates of synovitis (22% and 10%) and cyst formation (0%-18% and 13%-15%). There was a higher proportion of patients with incomplete graft integration within the femoral tunnel in the PEEK group as compared with the titanium group (10% vs 0%, P = .03); however, the authors suggest that metal artifact precluded proper assessment of the graft in the titanium group by MRI. Tunnel volumes also appeared to be equivalent in the 2 groups and were measured with a novel technique that was highly reproducible in the PEEK group secondary to the absence of flare. CONCLUSION Two-year clinical analysis of PEEK interference screws for femoral and tibial fixation of ACL reconstructions showed equivalent clinical performance to titanium interference screws. Given the excellent mechanical characteristics, biological compatibility, and absence of metal artifact on MRI, PEEK has become our material of choice for interference screw fixation in ACL reconstruction.
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Affiliation(s)
- Sarah Shumborski
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Emma Heath
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Lucy J Salmon
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Justin P Roe
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | | | - Michael Facek
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia
| | - Leo A Pinczewski
- North Sydney Orthopaedic and Sports Medicine Centre, Sydney, Australia.,University of Notre Dame, Sydney, Australia
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Ra HJ, Celik H, Kim HJ, Lee DH. Femoral tunnel widening is similar between anteromedial portal and transtibial techniques following single-bundle anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2019; 27:626-635. [PMID: 30306239 DOI: 10.1007/s00167-018-5204-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE In anterior cruciate ligament (ACL) reconstruction, there is concern regarding the potential risk of femoral tunnel widening in the anteromedial portal (AMP) technique due to the acute graft-bending angle at the aperture and the more elliptical aperture shape of the femoral tunnel compared to the transtibial (TT) techniques. Therefore, the aim of the current systematic review and meta-analysis was to compare the femoral tunnel widening between the AMP and TT techniques in patients who underwent ACL reconstruction. METHODS It should be included the studies that reported on femoral tunnel widening in patients who underwent single-bundle ACL reconstruction, using soft-tissue tendon graft, with AMP and/or TT techniques. Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACL reconstruction. RESULTS Twenty-one studies were finally included in this meta-analysis. The pooled changes of absolute millimeters of tunnel widening from the immediate postoperative status to the last follow-up did not differ significantly between the AMP and TT techniques at both the aperture [3.31 mm, 95% confidence interval (CI) 1.7-5.0. mm versus 2.9 mm, 95% CI 2.4-3.4 mm, P = n.s.] and the midportion (3.5 mm, 95% CI 0.8-6.3 mm versus 3.0 mm, 95% CI 2.2-3.9 mm, P = n.s.) of the femoral tunnel. No significant difference was observed between the two techniques in the relative percentage of femoral tunnel widening (AMP; 28.8%, 95% CI 14.8-42.9% vs. TT; 29.7%, 95% CI 15.6-43.7%, P = n.s.). CONCLUSION No significant difference in femoral tunnel widening was observed between the AMP and TT techniques, both in absolute millimeter and relative percentage, in patients who underwent single-bundle ACL reconstruction. This finding could alleviate the potential concerns associated with femoral tunnels being wider for the AMP than for the TT technique. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ho Jong Ra
- Department of Orthopaedic Surgery, College of Medicine, Gangneung Asan Hospital, Ulsan University, Gangneung, Republic of Korea
| | - Haluk Celik
- Department of Orthopaedic Surgery, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Hyun-Jun Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, 06351, Seoul, South Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, 06351, Seoul, South Korea.
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de Padua VBC, Vilela JCR, Espindola WA, Godoy RCG. BONE TUNNEL ENLARGEMENT WITH NON-METALLIC INTERFERENCE SCREWS IN ACL RECONSTRUCTION. ACTA ORTOPEDICA BRASILEIRA 2018; 26:305-308. [PMID: 30464710 PMCID: PMC6220656 DOI: 10.1590/1413-785220182605199995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 06/26/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare the widening of bone tunnels between poly-etheretherketone (PEEK), absorbable polylactic acid DL (PLDL) and tricalcium phosphate (TCP) interference screws in anterior cruciate ligament (ACL) reconstruction. METHODS Three groups of patients undergoing ACL reconstruction with at least 1 year of follow-up using the out-in drilling technique and hamstring as a graft were assessed. The patients were divided according to the type of interference screw used (PEEK, PLDL and TCP). Computed tomography (CT) was performed to measure the greatest femoral and tibial tunnel widening regarding to the initial tunnel, and then it was compared between groups. RESULTS Mean widening in group 1 (PEEK) was 39.56% (SD 16%) in the femoral tunnel and 33.65% (SD 20%) in the tibia. In group 2 (PLDL) mean widening was 48.43% in the femoral tunnel (SD 18%) and 35.24% (SD 13%) in the tibial tunnel. In group 3 (TCP) mean widening was 44.51% in the femur (SD 14%) and 36.83% in the tibia (SD 14%). The comparison between groups (PLDL-PEEK, PLDL-TCP, PEEK-TCP) shows no statistically significant difference. CONCLUSION Bone tunnel enlargement values after ACL reconstruction with the use of different types of materials (bioinert and biomaterials) of interference screws (PEEK, PLDL and TCP) were similar. Level of Evidence III, Comparative retrospective study.
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Affiliation(s)
- Vitor Barion Castro de Padua
- Associação Beneficíente Hospital Universitário (ABHU), Marília, SP, Brazil
- Clínica Traumato-Ortopédica Prof. Dr. Hilário Maldonado, Marília, SP, Brazil
| | - Júlio Cesar Rodrigues Vilela
- Associação Beneficíente Hospital Universitário (ABHU), Marília, SP, Brazil
- Clínica Traumato-Ortopédica Prof. Dr. Hilário Maldonado, Marília, SP, Brazil
| | - Wendel Aculha Espindola
- Associação Beneficíente Hospital Universitário (ABHU), Marília, SP, Brazil
- Clínica Traumato-Ortopédica Prof. Dr. Hilário Maldonado, Marília, SP, Brazil
| | - Rafael Cassiolato Garcia Godoy
- Associação Beneficíente Hospital Universitário (ABHU), Marília, SP, Brazil
- Clínica Traumato-Ortopédica Prof. Dr. Hilário Maldonado, Marília, SP, Brazil
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13
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Li G, Hosseini A, Gadikota H, Gill T. A Novel Graft Fixation Technique for Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Grafts. J Med Device 2017. [DOI: 10.1115/1.4038307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study evaluated the biomechanical efficacy of single-tunnel double-bundle anterior cruciate ligament (ACL) reconstruction technique. The graft construct is achieved using a novel fixation device that splits an ACL (SPACL) graft into two bundles, recreating the anteromedial (AM) and posterolateral (PL) bundles for ACL reconstruction. A pullout strength test of the SPACL was performed using a 7-mm bovine digital extensor tendon graft. The capability in restoration of knee kinematics after SPACL reconstruction was investigated using cadaveric human knees on a robotic testing system under an anterior tibial load of 134 N and a simulated quadriceps load of 400 N. The data indicated that the SPACL graft has a pullout strength of 823.7±172.3 N. Under the 134 N anterior tibial load, the anteroposterior joint laxity had increased constraint using the SPACL reconstruction but not significantly (p > 0.05) at all selected flexion angles. Under the 400 N quadriceps load, no significant differences were observed between the anterior tibial translation of intact knee and SPACL conditions at all selected flexion angles, but the SPACL graft induced a significant increase in external tibial rotation compared to the intact knee condition at all selected flexion angles with a maximal external rotation of −3.20 deg ±3.6 deg at 90 deg flexion. These data showed that the SPACL technique is equivalent or superior to existing ACL reconstruction techniques in restoration of knee laxity and kinematics. The new SPACL reconstruction technique could provide a valuable alternation to contemporary ACL reconstruction surgery by more closely recreating native ACL kinematics.
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Affiliation(s)
- Guoan Li
- Orthopaedic Biomechanics Lab, Department of Orthopaedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Newton, MA 02462 e-mail:
| | - Ali Hosseini
- Orthopaedic Biomechanics Lab, Department of Orthopaedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Newton, MA 02462
| | - Hemanth Gadikota
- Orthopaedic Biomechanics Lab, Department of Orthopaedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Newton, MA 02462
| | - Thomas Gill
- Orthopaedic Biomechanics Lab, Department of Orthopaedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Newton, MA 02462
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Ozel O, Yucel B, Orman O, Demircay E, Mutlu S. Comparison of Anteromedial and Transtibial ACL Reconstruction Using Expandable Fixation. Orthopedics 2017; 40:e532-e537. [PMID: 28399324 DOI: 10.3928/01477447-20170404-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 02/20/2017] [Indexed: 02/03/2023]
Abstract
The influence of anatomical or nonanatomical femoral tunnel position on tunnel widening and clinical outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction is not fully understood. This retrospective study examined the influence of tunnel width and placement on anterior knee stability and clinical outcomes after ACL reconstruction using the AperFix System (Cayenne Medical Inc, Scottsdale, Arizona), a direct expandable fixation technique with autologous hamstring grafts. The records of 80 patients (79 men and 1 woman) who underwent ACL reconstruction were evaluated. In 38 patients, anatomical femoral tunnel placement was performed via an accessory medial portal (anteromedial group); in the remaining 42 patients, the femoral tunnel was positioned nonanatomically using a transtibial technique (transtibial group). Mean follow-up was 40.7 months (range, 27-60 months). Postoperative knee kinetics were measured, and clinical outcomes were assessed using International Knee Documentation Committee, Lysholm, and Tegner scores. Femoral tunnel widening was measured by comparing postoperative radiographs with final follow-up radiographs. Femoral tunnel width was significantly greater (P<.001) and anterior knee translation was significantly higher (P=.01) in the transtibial group. Lysholm and Tegner scores were not significantly different (P>.05) between the 2 groups. These findings suggest that femoral tunnel widening is associated with increased anterior joint laxity when a direct fixation technique is used for ACL reconstruction, particularly in nonanatomically positioned femoral tunnels. Anatomical femoral tunnel placement provides better anterior stability and less tunnel widening than transtibial tunnel placement; however, these benefits did not produce a detectable advantage in clinical outcomes measures. [Orthopedics. 2017; 40(3):e532-e537.].
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Lanzetti RM, Monaco E, De Carli A, Grasso A, Ciompi A, Sigillo R, Argento G, Ferretti A. Can an adjustable-loop length suspensory fixation device reduce femoral tunnel enlargement in anterior cruciate ligament reconstruction? A prospective computer tomography study. Knee 2016; 23:837-41. [PMID: 27338510 DOI: 10.1016/j.knee.2016.01.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 12/11/2015] [Accepted: 01/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to compare bone femoral tunnel enlargement in patients who underwent anterior cruciate ligament (ACL) transtibial reconstruction using an adjustable-loop length suspensory fixation device and a fixed-loop length suspensory fixation device. METHODS All patients treated for ACL reconstruction with an ipsilateral hamstring between March 2013 and March 2014 were evaluated. Subjects were assigned to Group A (TightRope™ (TR) femoral fixation) or Group B (EndoButton® (EB) femoral fixation). All patients were evaluated with the Lachman test, pivot-shift test, 2000 International Knee Documentation Committee (IKDC) knee examination and KT1000 arthrometer. The subjective evaluation was performed using the 2000 IKDC Subjective Knee score, the Lysholm knee score, and the Tegner activity scale. CT examination was performed to evaluate femoral tunnel enlargement at four different levels. All patients were assessed at a 12month follow-up visit. Power analysis was performed a priori in accordance with the femoral tunnel enlargement values from the CT scans. Differences with P-values of ≤0.05 were considered to be statistically significant. RESULTS The groups were homogenous at baseline with regard to age, gender, BMI, dominance and disease duration. At the final follow-up, no statistically significant differences (P>0.05) were found according to subjective and objective clinical outcome measures. According to the femoral tunnel enlargement, no statistically significant difference was found between the two groups (P>0.05). CONCLUSION In transtibial ACL reconstruction, the use of a fixed or adjustable-loop length device products, on the femoral side, led to similar clinical and radiological results.
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Affiliation(s)
- R M Lanzetti
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189 Rome, Italy.
| | - E Monaco
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189 Rome, Italy
| | - A De Carli
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189 Rome, Italy
| | - A Grasso
- Villa Valeria Clinic, Rome, Italy
| | - A Ciompi
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189 Rome, Italy
| | - R Sigillo
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189 Rome, Italy
| | - G Argento
- Diagnostic Imaging Unit, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189 Rome, Italy
| | - A Ferretti
- Orthopaedic Unit and "Kirk Kilgour" Sports Injury Centre, S. Andrea Hospital, University of Rome "La Sapienza", Italy, Via di Grottarossa 1035, 00189 Rome, Italy
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Caekebeke P, Corten K, Duerinckx J. Distal biceps tendon repair: comparison of clinical and radiological outcome between bioabsorbable and nonabsorbable screws. J Shoulder Elbow Surg 2016; 25:349-54. [PMID: 26927430 DOI: 10.1016/j.jse.2015.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal biceps tendon repair to the radial tuberosity can be conducted by means of an interference screw in combination with a transosseous button. Bioabsorbable interference screws have been associated with complications such as severe osteolytic reactions. We questioned whether patients with a distal biceps tendon repair with bioabsorbable poly-L-lactide (PLLA) screws had different functional, clinical, and radiologic outcome than patients with nonabsorbable poly-ether ether ketone (PEEK) screws. METHODS Between 2010 and 2014, 23 patients with an acute distal biceps tendon rupture were treated with reinsertion of the distal biceps tendon in a bone tunnel at the radial tuberosity through a single anterior incision using a transosseous button combined with an interference screw. A PLLA screw was used in 12 patients and a PEEK screw in 11 patients. All patients were retrospectively evaluated with a minimal follow-up of 1 year clinically and by means of the visual analog scale for pain, Mayo Elbow Performance Score, and Disabilities of Arm, Shoulder and Hand Outcome Measure score. Bone tunnel volume was measured with computed tomography segmentation. RESULTS Elbow mobility and arm and forearm circumference were symmetric for all patients. The visual analog scale for pain was 0.2 in the PLLA group and 0.7 in the PEEK group. The Disabilities of Arm, Shoulder and Hand score and Mayo Elbow Performance Score were 5.4 and 98.7 in the PLLA group vs. 3.1 and 95.9 in the PEEK group. Bone tunnel enlargement of 43% in the PLLA and 38% in the PEEK group was noted. CONCLUSIONS Clinical and functional outcome at more than 1 year after distal biceps tendon repair was excellent in both groups. Bone tunnel widening occurred in all patients.
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Affiliation(s)
| | - Kristoff Corten
- Orthopaedic Department, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Joris Duerinckx
- Orthopaedic Department, Ziekenhuis Oost-Limburg, Genk, Belgium
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Abstract
The purpose of the study was to assess the fixation durability of the AperFix System (Cayenne Medical, Inc, Scottsdale, Arizona) used in arthroscopic reconstruction of the anterior cruciate ligament. The AperFix System consists of a femoral and tibial component designed to secure either allograft or autograft. The outcomes of 185 knees (180 patients) were retrospectively reviewed at a minimum of 2 years postoperatively. Mean age at surgery was 31±12 years (range, 16-68 years). Of these, a convenience sample was seen prospectively to obtain radiographs and to assess functional status. No cases occurred of fixation failure involving loss of graft positioning or pullout. No patients required revision anterior cruciate ligament reconstruction. In 2 knees, the tip of the central fixation pin had to be modified as a result of hardware prominence and soft tissue irritation at 434 and 159 days postoperatively, respectively. In 4 knees, tibial screw removal occurred secondary to local discomfort (mean, 239 days; range, 105-371 days). No other recurring adverse events or problems associated with the implants were identified. Forty-four patients were evaluated prospectively at a mean follow-up of 32±7 months. Lysholm scores and patient satisfaction scores were positively and significantly correlated with Tegner activity scores (r=0.61; P<.0001). Eighty-two (82%) patients had a KT-1000 (Medmetric Corp, San Diego, California) side-to-side difference of less than 3 mm (average, 0.4 mm). No indications of femoral device migration existed when comparing follow-up and immediate postoperative radiographs. The AperFix System provides durable femoral aperture fixation during anterior cruciate ligament reconstruction with excellent clinical outcome scores and a low complication rate.
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Affiliation(s)
- John W Uribe
- UHZ Sports Medicine Institute, Doctors Hospital, Baptist Health South Florida, Coral Gables, USA
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