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Femoral-tibial fixation affects risk of revision and reoperation after anterior cruciate ligament reconstruction using hamstring autograft

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Newer fixation devices for hamstring (HS) autograft have been introduced over the years, yet the impact of these devices on ACLR outcomes requiring surgical intervention remains unclear. We sought to evaluate the risk of aseptic revision and reoperation after HS autograft ACLR according to various femoral-tibial fixation methods.

Methods

A cohort study was conducted using the Kaiser Permanente ACLR Registry. Primary isolated unilateral ACLR patients who received a HS autograft were identified (2007–2014). Fixation devices were categorized as crosspin, interference, suspensory, or combination (defined as more than one fixation device used on the same side) and femoral-tibial fixation groups used in more than 500 ACLR were evaluated. Cox proportional-hazard regression was used to evaluate the association between femoral-tibial fixation method and outcomes while adjusting for confounders.

Results

6,593 primary ACLR were included. Four femoral-tibial fixation groups had more than 500 ACLR: suspensory–interference (n = 3004, 45.6%), interference–interference (n = 1659, 25.2%), suspensory–combination (n = 1103, 16.7%), and crosspin–interference (n = 827, 12.5%). After adjusting for covariates, revision risk was lower for crosspin–interference (HR = 0.43, 95% CI 0.29–0.65) and interference–interference (HR = 0.63, 95% CI 0.41–0.95) methods compared to the suspensory–interference. In contrast, reoperation risk was higher for crosspin–interference (HR = 2.13, 95% CI 1.37–3.32) and suspensory–combination (HR = 1.68, 95% CI 1.04–2.69) methods compared to suspensory–interference.

Conclusions

ACLR using HS autograft appears to have the lowest risk of aseptic revision when crosspin or interference fixation is used on the femoral side and is coupled with an interference screw on the tibial side.

Level of evidence

III.

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Abbreviations

ACLR:

Anterior cruciate ligament reconstruction

ACLRR:

Anterior cruciate ligament reconstruction registry

AM:

Anteromedial

BMI:

Body mass index

BPTB:

Bone patellar tendon bone

CI:

Confidence interval

EHR:

Electronic health record

HS:

Hamstring

HR:

Hazard ratio

IQR:

Interquartile range

NKLR:

Norwegian Knee Ligament Register

SD:

Standard deviation

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Acknowledgements

The authors acknowledge the Kaiser Permanente orthopaedic surgeons who contribute to the Kaiser Permanente ACLR Registry as well as the Surgical Outcomes and Analysis Department staff, which coordinates registry operations. The authors also acknowledge William E. Burfeind, MAS, and Tom S. Huon, BS, for their ongoing support of the Kaiser Permanente ACLR Registry database and quality control management.

Funding

No outside funding was obtained.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Southern California Permanente Medical Group, 6670 Alton Pkwy, Irvine, CA, 92618, USA

    Lindsey M. Spragg, Tadashi T. Funahashi & Rick P. Csintalan

  2. Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA

    Heather A. Prentice

  3. Department of Orthopaedics, University of California Irvine, Irvine, CA, USA

    Andrew Morris

  4. Department of Orthopaedics, Southern California Permanente Medical Group, Baldwin Park, CA, USA

    Gregory B. Maletis

Authors
  1. Lindsey M. Spragg
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Contributions

LMS, HAP, TTF, GBM, and RPC contributed to overall conception and design of the study. LMS, HAP, AM, TTF, GBM, and RPC took part in data acquisition. HAP completed the statistical analysis. LMS, HAP, and RPC drafted the manuscript. LMS, HAP, AM, TTF, GBM, and RPC reviewed the manuscript, contributed to revisions, gave approval of the final draft, and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Rick P. Csintalan.

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This study was approved by the Kaiser Permanente Institutional Review Board (#5691) prior to commencement.

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Spragg, L.M., Prentice, H.A., Morris, A. et al. Femoral-tibial fixation affects risk of revision and reoperation after anterior cruciate ligament reconstruction using hamstring autograft. Knee Surg Sports Traumatol Arthrosc 27, 3518–3526 (2019). https://doi.org/10.1007/s00167-019-05431-4

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