Advertisement

Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 14, Issue 8, pp 730–738 | Cite as

Prospective randomized clinical comparison of femoral transfixation versus bioscrew fixation in hamstring tendon ACL reconstruction—a preliminary report

  • Tim RoseEmail author
  • Pierre Hepp
  • Julia Venus
  • Christoph Stockmar
  • Christoph Josten
  • Helmut Lill
Knee

Abstract

The purpose of this study is to clinically evaluate hamstring tendon anterior cruciate ligament (ACL)-reconstruction using femoral fixation with bioresorbable interference screws and with a bioresorbable transfixation device. The ACL-reconstruction using the transfixation device at the femoral side leads to less knee laxity and therefore to a better clinical outcome for the patient. Prospective randomized clinical outcome study. From February 2002 to December 2002, a total of 68 patients with hamstring ACL reconstruction using a femoral fixation once with TransFix (n=38; m:22 and f:16; median age=28.5 range 15–47) and the second with bioscrew (BS) (n=30; m:20, f:10; median age=25.5 range 13–61) completed the follow-up period. Patients in each group got a clinical assessment at 3, 6, and 12 months after surgery. The measurement of anterior translation of the tibia has been performed using the Rolimeter® device. No significant differences in the knee laxity testing using the Rolimeter device were seen between both groups and over time within these groups. Ninety percent of all patients had functionally normal or near normal International Knee Documentation Committee (IKDC) knee ligament ratings. The TF-group included 17 grade A, 19 grade B, and 2 grade C knees, and the BS-group had 12 grade A, 13 grade B, and 5 grade C knees. The IKDC rating, the OAK-score, the Tegner-activity-score, and the Lysholm-score did not show significant differences between the TF-group and the BS-group. We disproved our hypothesis that the transfixation technique leads to less laxity and therefore to a better clinical outcome when compared to the use of BS. The clinical results in this study clarified that this technique is an effective and safe method for femoral hamstring fixation in ACL-reconstruction. However, this technique revealed no advantage compared to the bioscrew fixation technique within the short-term follow-up.

Keywords

Anterior cruciate ligament Hamstrings Transfix Interference screw Clinical outcome 

Reference

  1. 1.
    Adam F, Pape D, Steimer O, Kohn D, Rupp S (2001) Biomechanical properties of interference screw implantation in replacement of the anterior cruciate ligament with patellar and hamstring transplants. An experimental study using roentgen stereometry analysis (RSA). Orthopade 30:649–657CrossRefPubMedGoogle Scholar
  2. 2.
    Ahmad C, Gardner T, Groh M, Arnouk J, Levine W (2004) Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction (in process citation). Am J Sports Med 32:635–640CrossRefPubMedGoogle Scholar
  3. 3.
    Arangio GA, Chen C, Kalady M, Reed JF III (1997) Thigh muscle size and strength after anterior cruciate ligament reconstruction and rehabilitation. J Orthop Sports Phys Ther 26:238–243PubMedGoogle Scholar
  4. 4.
    Arnold MP, Kooloos J, van Kampen A (2001) Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 9:194–199PubMedGoogle Scholar
  5. 5.
    Balasch H, Schiller M, Friebel H, Hoffmann F (1999) Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer [see comments]. Knee Surg Sports Traumatol Arthrosc 7:204–208CrossRefPubMedGoogle Scholar
  6. 6.
    Becker R, Voigt D, Starke C, Heymann M, Wilson GA, Nebelung W (2001) Biomechanical properties of quadruple tendon and patellar tendon femoral fixation techniques. Knee Surg Sports Traumatol Arthrosc 9:337–342CrossRefPubMedGoogle Scholar
  7. 7.
    Breitfuss H, Frohlich R, Povacz P, Resch H, Wicker A (1996) The tendon defect after anterior cruciate ligament reconstruction using the midthird patellar tendon—a problem for the patellofemoral joint? Knee Surg Sports Traumatol Arthrosc 3:194–198CrossRefPubMedGoogle Scholar
  8. 8.
    Chmielewski TL, Stackhouse S, Axe MJ, Snyder-Mackler L (2004) A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture. J Orthop Res 22:925–930CrossRefPubMedGoogle Scholar
  9. 9.
    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 14:258–267PubMedCrossRefGoogle Scholar
  10. 10.
    Corry IS, Webb JM, Clingeleffer AJ, Pinczewski LA (1999) Arthroscopic reconstruction of the anterior cruciate ligament. A comparison of patellar tendon autograft and four-strand hamstring tendon autograft. Am J Sports Med 27:444–454PubMedGoogle Scholar
  11. 11.
    Galla M, Uffmann J, Lobenhoffer P (2004) Femoral fixation of hamstring tendon autografts using the TransFix device with additional bone grafting in an anteromedial portal technique. Arch Orthop Trauma Surg 124:281–284CrossRefPubMedGoogle Scholar
  12. 12.
    Ganko A, Engebretsen L, Ozer H (2000) The rolimeter: a new arthrometer compared with the KT-1000. Knee Surg Sports Traumatol Arthrosc 8:36–39CrossRefPubMedGoogle Scholar
  13. 13.
    Giurea M, Zorilla P, Amis A, 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 27:621–625PubMedGoogle Scholar
  14. 14.
    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 21:25–33PubMedCrossRefGoogle Scholar
  15. 15.
    Harner CD, Marks PH, Fu FH, Irrgang JJ, Silby MB, Mengato R (1994) Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique. Arthroscopy 10:502–512PubMedCrossRefGoogle Scholar
  16. 16.
    Hoher J, Livesay G, Ma C, Withrow J, Fu F, Woo S (1999) Hamstring graft motion in the femoral bone tunnel when using titanium button/polyester tape fixation. Knee Surg Sports Traumatol Arthrosc 7:215–219CrossRefPubMedGoogle Scholar
  17. 17.
    Jager A (1998) Impingement Index: a new calculation tool to predict an intercondylar notchimpingement after anterior cruciate ligament reconstruction in knee flexion. Orthop Res Soc 23:1114Google Scholar
  18. 18.
    Keays SL, Bullock-Saxton J, Keays AC, Newcombe P (2001) Muscle strength and function before and after anterior cruciate ligament reconstruction using semitendonosus and gracilis. Knee 8:229–234CrossRefPubMedGoogle Scholar
  19. 19.
    Kobayashi A, Higuchi H, Terauchi M, Kobayashi F, Kimura M, Takagishi K (2004) Muscle performance after anterior cruciate ligament reconstruction. Int Orthop 28:48–51CrossRefPubMedGoogle Scholar
  20. 20.
    Kvist J (2004) Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med 34:269–280CrossRefPubMedGoogle Scholar
  21. 21.
    L’Insalata J, Klatt B, Fu F, Harner C (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238CrossRefPubMedGoogle Scholar
  22. 22.
    Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Arthroscopy 19:297–304PubMedCrossRefGoogle Scholar
  23. 23.
    Ma C, Francis K, Towers J, Irrgang J, Fu F, Harner C (2004) Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 20:122–128PubMedCrossRefGoogle Scholar
  24. 24.
    Nakamura N, Horibe S, Sasaki S, Kitaguchi T, Tagami M, Mitsuoka T, Toritsuka Y, Hamada M, Shino K (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18:598–602PubMedCrossRefGoogle Scholar
  25. 25.
    Nebelung W, Becker R, Urbach D, Ropke M, Roessner A (2003) Histological findings of tendon-bone healing following anterior cruciate ligament reconstruction with hamstring grafts. Arch Orthop Trauma Surg 123:158–163PubMedGoogle Scholar
  26. 26.
    Rose T, Engel T, Bernhard J, Hepp P, Josten C, Lill H (2004) Differences in the rehabilitation period following two methods of anterior cruciate ligament replacement: semitendinosus/gracilis tendon vs. ligamentum patellae. Knee Surg Sports Traumatol Arthrosc 12:189–197CrossRefPubMedGoogle Scholar
  27. 27.
    Smith FW, Rosenlund EA, Aune AK, MacLean JA, Hillis SW (2004) Subjective functional assessments and the return to competitive sport after anterior cruciate ligament reconstruction. Br J Sports Med 38:279–284CrossRefPubMedGoogle Scholar
  28. 28.
    Sommer C, Friederich NF, Muller W (2000) Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 8:207–213CrossRefPubMedGoogle Scholar
  29. 29.
    Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position. Anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146CrossRefPubMedGoogle Scholar
  30. 30.
    Weiler A, Hoffmann R, Bail H, Rehm O, Sudkamp N (2002) Tendon healing in a bone tunnel. Part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18:124–135PubMedCrossRefGoogle Scholar
  31. 31.
    Weiler A, Peine R, Pashmineh-Azar A, Abel C, Sudkamp N, Hoffmann R (2002) Tendon healing in a bone tunnel. Part I: biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18:113–123PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Tim Rose
    • 1
    • 2
    Email author
  • Pierre Hepp
    • 1
  • Julia Venus
    • 1
  • Christoph Stockmar
    • 1
  • Christoph Josten
    • 1
  • Helmut Lill
    • 1
  1. 1.Department of Trauma and Reconstructive SurgeryUniversity of LeipzigLeipzigGermany
  2. 2.Abteilung und Poliklinik für SportorthopädieTechnische Universität MünchenMünchenGermany

Personalised recommendations