2025 ISAKOS Biennial Congress ePoster
Tibial Suspensory Fixation Demonstrated Similar Functional Outcomes And Stability With Lesser Tunnel Widening And Better Graft Incorporation Compared To Tibial Interference Screw In Hamstring Graft ACL Reconstruction -A Systematic Review And Meta-Analysis
Nayeem Zafar Hali, MBBS, MS(Ortho.), FRCS (Trauma & Orth.), Worcester UNITED KINGDOM
Hersh Punjani, MBChB, Worcester, West Bromwich UNITED KINGDOM
Muaaz Tahir, BSc, MBBS, FRCS, Birmingham UNITED KINGDOM
Jimmy Ng, BMBS, FRCS, Nottingham UNITED KINGDOM
Osama Adil Aweid, MBBS BSc MSc FRCS MFSEM, London UNITED KINGDOM
Tarek Boutefnouchet, MBChB MRCS PGCMed MSc FRCS (Tr&Orth) Dip. FIFA Med, Birmingham UNITED KINGDOM
Jarret M. Woodmass, MD, FRCSC, Winnipeg, MB CANADA
Peter Alberto D'Alessandro, MBBS Hons. (UWA) FRACS FAOrthA, Claremont, WA AUSTRALIA
Shahbaz S Malik, BSc, MB BCh, MSc (Orth Engin), LLM, FRCS (Tr&Orth), Birmingham UNITED KINGDOM
Worcestershire Acute Hospitals NHS Trust, Worcester, West Midlands, UNITED KINGDOM
FDA Status Not Applicable
Summary
Tibial suspensory fixation demonstrated similar functional outcome and stability when compared to tibial interference screw with the potential benefit of lesser tibial tunnel widening and better graft incorporation at a minimum follow up of 2 years.
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Abstract
Background
There is no consensus on optimal method of fixation of hamstring graft in ACL reconstruction on the tibial side compared to femoral side. The aim of this systematic review is to compare tibial suspensory fixation (TSF) with tibial interference screw (TIS) for clinical and radiological outcomes.
Methods
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines using MEDLINE, PubMed and Embase databases. The review was registered with the PROSPERO with registration number CRD42024580794. Clinical comparative studies of ACL reconstruction with hamstring autograft with TSF and TIS were included. Studies were appraised using the MINOR tool.
Results
17 clinical comparative studies (TSF, n=4262; TIS, n=3085) met eligible criteria. 72.9% (TSF) and 75.7% (TIS) were males. Mean follow up was 26.4 months (range 24 to 40 months) for clinical outcomes and 11.8 months (range 6 to 24 months) for radiological outcome.
Clinical studies reported no statistically significant difference for knee functional scores -IKDC, Tegner and VAS pain scores. Lysholm score was marginally better in TSF group compared to TIS except for one study. The studies also reported no statistically significant difference in knee laxity. Two studies demonstrated superior flexor strength at 2 years with TSF compared to TIS. No major complications were reported in most of the clinical studies except one study which showed higher revision rate with TIS (TSF 3.4% vs TIS 5.4%, p<0.001). Radiologically, the studies showed statistically significant tibial tunnel widening with TIS compared to TSF.
Meta-analysis from these studies showed no significant difference in IKDC score, Tegner score and Knee laxity on KT-1000 arthrometer. However, there was significant difference in Lysholm score and tibial tunnel widening in favour of TSF.
Conclusion
Tibial suspensory fixation (TSF) demonstrated similar functional outcome and stability when compared to tibial interference screw (TIS) with the potential benefit of lesser tibial tunnel widening and better graft incorporation at a minimum follow up of 2 years.