Abstract
The purpose of our study was that to systematically review the fixation techniques for the ACL reconstruction and associated clinical outcomes at the early follow-up. Systematic search on three electronic databases (Cochrane register, Medline and Embase) of fixation devices used for primary ACL reconstruction with doubled semitendinosus and gracilis and bone–patellar tendon–bone autografts in randomized clinical trials of level I and II of evidence published from January 2001 to December 2011. Therapeutic studies collected were with a minimum 12-month follow-up, and the clinical outcomes were evaluated by at least one of International Knee Documentation Committee, Lysholm and Tegner functional scales and at least one of the following knee stability tests: arthrometric AP tibial translation, Lachman test and pivot-shift test. Nineteen articles met the inclusion criteria. At the femoral side cross-pin, metallic interference screw, bioabsorbable interference screw, and suspensory device were used in 32.3, 27.3, 24.8, 15.5 % of patients, respectively. At the tibial side fixation was achieved with metallic interference screw, bioabsorbable interference screw, screw and plastic sheath, screw post and cross-pin in 38.7, 31, 15.7, 12.8, and 1.7 % of patients, respectively. Side-to-side anterior–posterior tibial translation was 1.9 ± 0.9, 1.5 ± 0.9, 1.5 ± 0.8, 2.2 ± 0.4 mm for metallic interference screw, bioabsorbable screw, cross-pin and suspensory device, respectively. At least two-third of all the patients achieved good-to-excellent clinical outcomes. Rate of failure was 6.1, 3.3, 1.7 and 1.2 % for bioabsorbable interference screw, metallic interference screw, cross-pin and suspensory device, respectively. Clinical outcomes are good to excellent in almost two-third of the patients but several pitfalls that affect the current fixation techniques as graft tensioning such as graft-tunnel motion are still unaddressed.
Similar content being viewed by others
References
Woo SL, Thomas M, Chan Saw SS (2004) Contribution of biomechanics, orthopaedics and rehabilitation: the past present and future. Surgeon 2:125–136
Fu FH, Shen W, Starman JS, Okeke N, Irrgang JJ (2008) Primary anatomic double-bundle anterior cruciate ligament reconstruction: a preliminary 2-year prospective study. Am J Sports Med 36:1263–1274
Tiamklang T, Sumanont S, Foocharoen T, Laopaiboon M (2012) Double-bundle versus single-bundle reconstruction for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 11:CD008413
Aglietti P, Giron F, Buzzi R, Biddau F, Sasso F (2004) Anterior cruciate ligament reconstruction: bone–patellar tendon–bone compared with double semitendinosus and gracilis tendon grafts: a prospective, randomized clinical trial. J Bone Jt Surg Am 86A:2143–2155
Zamarra G, Fisher MB, Woo SL, Cerulli G (2010) Biomechanical evaluation of using one hamstrings tendon for ACL reconstruction: a human cadaveric study. Knee Surg Sports Traumatol Arthrosc 18:11–19
Ciccone WJ 2nd, Bratton DR, Weinstein DM, Elias JJ (2006) Viscoelasticity and temperature variations decrease tension and stiffness of hamstring tendon grafts following anterior cruciate ligament reconstruction. J Bone Jt Sur Am 88:1071–1078
Graf BK, Vanderby R Jr, Ulm MJ, Rogalski RP, Thielke RJ (1994) Effect of preconditioning on the viscoelastic response of primate patellar tendon. Arthroscopy 10:90–96
Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S (1991) Tensile properties of the human femur-anterior cruciate ligament-tibia complex. The effects of specimen age and orientation. Am J Sports Med 19:217–225
Nicholas SJ, D’Amato MJ, Mullaney MJ, Tyler TF, Kolstad K, McHugh MP (2004) A prospectively randomized double-blind study on the effect of initial graft tension on knee stability after anterior cruciate ligament reconstruction. Am J Sports Med 32:1881–1886
Clark R, Olsen RE, Larson BJ, Goble EM, Farrer RP (1998) Cross-pin femoral fixation: a new technique for hamstring anterior cruciate ligament reconstruction of the knee. Arthroscopy 14:258–267
Kousa P, Jarvinen TL, Vihavainen M, Kannus P, Jarvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part I: femoral site. Am J Sports Med 31:174–181
Kousa P, Jarvinen TL, Vihavainen M, Kannus P, Jarvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part II: tibial site. Am J Sports Med 31:182–188
Karchin A, Hull ML, Howell SM (2004) Initial tension and anterior load-displacement behavior of high-stiffness anterior cruciate ligament graft constructs. J Bone Jt Surg Am 86A:1675–1683
Milano G, Mulas PD, Ziranu F, Piras S, Manunta A, Fabbriciani C (2006) Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: a biomechanical analysis. Arthroscopy 22:660–668
Drogset JO, Grontvedt T, Tegnander A (2005) Endoscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone grafts fixed with bioabsorbable or metal interference screws: a prospective randomized study of the clinical outcome. Am J Sports Med 33:1160–1165
Drogset JO, Strand T, Uppheim G, Odegard B, Boe A, Grontvedt T (2010) Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods. Knee Surg Sports Traumatol Arthrosc 18:1085–1093
Eriksson K, Anderberg P, Hamberg P, Lofgren AC, Bredenberg M, Westman I et al (2001) A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Jt Surg Br 83:348–354
Jarvela T, Moisala AS, Sihvonen R, Jarvela S, Kannus P, Jarvinen M (2008) Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med 36:290–297
Laxdal G, Kartus J, Eriksson BI, Faxen E, Sernert N, Karlsson J (2006) Biodegradable and metallic interference screws in anterior cruciate ligament reconstruction surgery using hamstring tendon grafts: prospective randomized study of radiographic results and clinical outcome. Am J Sports Med 34:1574–1580
Rose T, Hepp P, Venus J, Stockmar C, Josten C, Lill H (2006) Prospective randomized clinical comparison of femoral transfixation versus bioscrew fixation in hamstring tendon ACL reconstruction–a preliminary report. Knee Surg Sports Traumatol Arthrosc 14:730–738
Stener S, Ejerhed L, Sernert N, Laxdal G, Rostgard-Christensen L, Kartus J (2010) A long-term, prospective, randomized study comparing biodegradable and metal interference screws in anterior cruciate ligament reconstruction surgery: radiographic results and clinical outcome. Am J Sports Med 38:1598–1605
Harilainen A, Sandelin J (2009) A prospective comparison of 3 hamstring ACL fixation devices–Rigidfix, BioScrew, and Intrafix–randomized into 4 groups with 2 years of follow-up. Am J Sports Med 37:699–706
Harilainen A, Sandelin J, Jansson KA (2005) Cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons: results of a controlled prospective randomized study with 2-year follow-up. Arthroscopy 21:25–33
Mariani PP, Camillieri G, Margheritini F (2001) Transcondylar screw fixation in anterior cruciate ligament reconstruction. Arthroscopy 17:717–723
Stengel D, Casper D, Bauwens K, Ekkernkamp A, Wich M (2009) Bioresorbable pins and interference screws for fixation of hamstring tendon grafts in anterior cruciate ligament reconstruction surgery: a randomized controlled trial. Am J Sports Med 37:1692–1698
Myers P, Logan M, Stokes A, Boyd K, Watts M (2008) Bioabsorbable versus titanium interference screws with hamstring autograft in anterior cruciate ligament reconstruction: a prospective randomized trial with 2-year follow-up. Arthroscopy 24:817–823
Ibrahim SA, Hamido F, Al Misfer AK, Mahgoob A, Ghafar SA, Alhran H (2009) Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures. J Bone Jt Surg Br 91:1310–1315
Colvin A, Sharma C, Parides M, Glashow J (2011) What is the best femoral fixation of hamstring autografts in anterior cruciate ligament reconstruction? A meta-analysis. Clin Orthop Related Res 469:1075–1081
Micucci CJ, Frank DA, Kompel J, Muffly M, Demeo PJ, Altman GT (2010) The effect of interference screw diameter on fixation of soft-tissue grafts in anterior cruciate ligament reconstruction. Arthroscopy 26:1105–1110
Ahmad CS, Gardner TR, Groh M, Arnouk J, Levine WN (2004) Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction. Am J Sports Med 32:635–640
Giurea M, Zorilla P, Amis AA, Aichroth P (1999) Comparative pull-out and cyclic-loading strength tests of anchorage of hamstring tendon grafts in anterior cruciate ligament reconstruction. Am J Sports Med 27:621–625
Fu K, Pack DW, Klibanov AM, Langer R (2000) Visual evidence of acidic environment within degrading poly(lactic-co-glycolic acid) (PLGA) microspheres. Pharm Res 17:100–106
Monaco E, Labianca L, Speranza A, Agro AM, Camillieri G, D’Arrigo C et al (2010) Biomechanical evaluation of different anterior cruciate ligament fixation techniques for hamstring graft. J Ortho Sci 15:125–131
Hoher J, Livesay GA, Ma CB, Withrow JD, Fu FH, Woo SL (1999) Hamstring graft motion in the femoral bone tunnel when using titanium button/polyester tape fixation. Knee Surg Sports Traumatol Arthrosc 7:215–219
Choi NH, Son KM, Yoo SY, Victoroff BN (2012) Femoral tunnel widening after hamstring anterior cruciate ligament reconstruction with bioabsorbable transfix. Am J Sports Med 40:383–387
Clancy WG Jr, Narechania RG, Rosenberg TD, Gmeiner JG, Wisnefske DD, Lange TA (1981) Anterior and posterior cruciate ligament reconstruction in rhesus monkeys. J Bone Jt Surg Am 63:1270–1284
Weiler A, Hoffmann RF, Sudkamp NP, Siepe CJ, Haas NP (1999) Replacement of the anterior cruciate ligament. Biomechanical studies for patellar and semitendinosus tendon fixation with a poly(D, L-lactide) interference screw. Der Unfallchirurg 102:115–123
L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238
Jorgensen U, Thomsen HS (2000) Behavior of the graft within the bone tunnels following anterior cruciate ligament reconstruction, studied by cinematic magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 8:32–35
Rodeo SA, Kawamura S, Kim HJ, Dynybil C, Ying L (2006) Tendon healing in a bone tunnel differs at the tunnel entrance versus the tunnel exit: an effect of graft-tunnel motion? Am J Sports Med 34:1790–1800
Brucker PU, Lorenz S, Imhoff AB (2006) Aperture fixation in arthroscopic anterior cruciate ligament double-bundle reconstruction. Arthroscopy 22(1250):e1–e6
Brand J Jr, Weiler A, Caborn DN, Brown CH Jr, Johnson DL (2000) Graft fixation in cruciate ligament reconstruction. Am J Sports Med 28:761–774
Kim SJ, Bae JH, Song SH, Lim HC (2013) Bone tunnel widening with autogenous bone plugs versus bioabsorbable interference screws for secondary fixation in ACL reconstruction. J Bone Jt Surg Am 95:103–108
Austin JC, Phornphutkul C, Wojtys EM (2007) Loss of knee extension after anterior cruciate ligament reconstruction: effects of knee position and graft tensioning. J Bone Jt Surg Am 89:1565–1574
Numazaki H, Tohyama H, Nakano H, Kikuchi S, Yasuda K (2002) The effect of initial graft tension in anterior cruciate ligament reconstruction on the mechanical behaviors of the femur-graft-tibia complex during cyclic loading. Am J Sports Med 30:800–805
Kaeding C, Farr J, Kavanaugh T, Pedroza A (2005) A prospective randomized comparison of bioabsorbable and titanium anterior cruciate ligament interference screws. Arthroscopy 21:147–151
Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH (2004) Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 20:122–128
Moisala AS, Jarvela T, Paakkala A, Paakkala T, Kannus P, Jarvinen M (2008) Comparison of the bioabsorbable and metal screw fixation after ACL reconstruction with a hamstring autograft in MRI and clinical outcome: a prospective randomized study. Knee Surg Sports Traumatol Arthrosc 16:1080–1086
Price R, Stoney J, Brown G (2010) Prospective randomized comparison of endobutton versus cross-pin femoral fixation in hamstring anterior cruciate ligament reconstruction with 2-year follow-up. ANZ J Surg 80:162–165
Sherman SL, Chalmers PN, Yanke AB, Bush-Joseph CA, Verma NN, Cole BJ et al (2012) Graft tensioning during knee ligament reconstruction: principles and practice. J Am Acad Ortho Surg 20:633–645
Fleming BC, Fadale PD, Hulstyn MJ, Shalvoy RM, Oksendahl HL, Badger GJ et al (2013) The effect of initial graft tension after anterior cruciate ligament reconstruction: a randomized clinical trial with 36-month follow-up. Am J Sports Med 41:25–34
Foldager C, Jakobsen BW, Lund B, Christiansen SE, Kashi L, Mikkelsen LR et al (2010) Tibial tunnel widening after bioresorbable poly-lactide calcium carbonate interference screw usage in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:79–84
Georgoulis AD, Ristanis S, Moraiti CO, Paschos N, Zampeli F, Xergia S et al (2010) ACL injury and reconstruction: clinical related in vivo biomechanics. Orthop Traumatol Surg Res 96:S119–S128
Ristanis S, Giakas G, Papageorgiou CD, Moraiti T, Stergiou N, Georgoulis AD (2003) The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc 11:360–365
Torres-Claramunt R, Pelfort X, Erquicia J, Gil-Gonzalez S, Gelber PE, Puig L et al (2012) Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes. Knee Surg Sports Traumatol Arthrosc
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Speziali, A., Delcogliano, M., Tei, M. et al. Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies. Musculoskelet Surg 98, 179–187 (2014). https://doi.org/10.1007/s12306-014-0338-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-014-0338-8