Purpose

To compare anterior cruciate ligament (ACL) autograft reconstruction using suspensory versus expandable femoral fixation, through the anteromedial portal.

Methods

After we performed prospective power analysis and obtained institutional review board and patient consent, 50 patients with ACL rupture were block randomized to the expandable (AperFix AM) or suspensory (non-adjustable cortical button) femoral fixation group (25 in each group). All patients received a 4-stranded autologous hamstring autograft through the anteromedial portal and were fixed in the tibia with the same implant (AperFix tibial-sheath and screw). 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 using CT imaging performed immediately postoperative and 12 months post-surgery. Secondary outcome measures included pain score on a visual analog scale (VAS), the subjective IKDC 2000 assessment form, the Lysholm score and the Tegner activity scale at 3,6,12, and 24 months post-surgery.

Results

The anteroposterior knee stability (KT-1000), showed no difference between groups at 24 months’ follow-up (p= .33). The percentile widening (%) of femoral and tibial tunnel at 1 year follow up, showed no difference also, except for higher values at the tibial coronal point T2 (p= .007) and tibial sagittal point T1 (p= .035) in the group of cortical button. Secondary clinical outcomes showed no statistical differences between groups at 3, 6, 12 and 24 months postoperatively. Numerical pain scale (VAS) was similar in both groups except for postoperative day 7, were the AperFix group showed better results (p= .012). There were no major intraoperative and late postoperative complications in any of the groups.

Conclusion

Our results showed no significant differences in knee AP stability, tunnel enlargement or other clinical outcomes comparing expandable versus cortical button fixation in anteromedial four-stranded hamstrings ACL reconstruction.