ISAKOS Congress 2021

2021 ISAKOS Biennial Congress ePoster

 

Anterior Cruciate Ligament Reconstruction with an Adjustable Suspensory Femoral Fixation. Is It a Good Fix?

Faiz Khan, FRCS MCh, Bridgend UNITED KINGDOM
Shaival Dalal, M.S.MRCS(Edinburgh), Bridgend UNITED KINGDOM
Ashish Batra, DNB Orthopaedics, Bridgend, Wales UNITED KINGDOM
Randy Guro, BSc, Bridgend UNITED KINGDOM
Rahul Kotwal, FRCS(Ortho), Bridgend UNITED KINGDOM
Amit Pramod Chandratreya, FRCS(Tr&Orth), MS(Orth), MCh(Orth), Cardiff, South Glamorgan UNITED KINGDOM

Department of Orthopaedics, Princess of Wales Hospital, Bridgend, Wales, UNITED KINGDOM

FDA Status Not Applicable

Summary

ACL reconstruction using adjustable cortical suspensory femoral fixation is a newer technique which seems to be safe and a good alternative to the standard interference screw fixation with a change in the method of cinching the button preventing pull-out of the loop from the bone plug with the advantage of circumferential host bone ingrowth on the bone plug with no screw in the femoral tunnel.

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Abstract

Aim.

Our aim was to assess and compare the outcomes of patients who had undergone primary ACL reconstruction with quadriceps tendon with bone block (QT) graft and bone patellar tendon bone (BTB) graft using adjustable suspensory femoral fixation versus interference femoral screw fixation.

Methods.

Seventy six patients underwent primary arthroscopic ACL reconstruction from 2008 to 2019 in a single centre study. There were 38 patients (20 QT and 18 BTB) in each group. The groups were matched for age, sex and type of graft. The technique of reconstruction was the same in both groups: independent tunnel placements, complete tibial tunnel and Inside out partial femoral tunnel. Suspensory fixation was undertaken with Arthrex Tightrope system and the screw fixation with PEEK screw. Mean age was 33.2 years. Mean interval from injury to surgery was 10.5 months. Clinical review was undertaken along with PROMS from NLR with EQ-5D, KOOS, IKDC and Tegner scores. Paired two-tailed student t-tests and Chi-square tests were employed for statistical analysis.

Results.

Mean follow up was 82 months (Range 17 to 154 months). There was significant improvement (p<0.05) in the mean EQ-5D VAS, EQ-5D Index, KOOS, IKDC and Tegner activity scores for both groups. There was no significant difference between the two groups (p>0.05). There was an associated meniscal tear in 18(23.7%) patients of whom 73.3 % underwent repair. In each group, 1 patient returned to theatre for intra-substance graft failure and 2 patients had manipulation for arthrofibrosis, all of whom had an uneventful recovery after the secondary procedure. Three patients had an intra-operative failure of suspensory fixation due to a technical error and were immediately converted to interference screws. The technique of cinching the BTB Tightrope to tension the graft was changed from the manufacturer’s recommendations to avoid the cutting out of the loop from the bone plug.

Conclusion.

ACL reconstruction using adjustable cortical suspensory femoral fixation is a newer technique which seems to be safe and a good alternative to the standard interference screw fixation. The change in the method of cinching the button may prevent pull-out of the loop from the bone plug. It has the advantage of circumferential host bone ingrowth on the bone plug with no screw in the femoral tunnel.

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