Skip to main content
SpringerLink
Log in

ZURUECKGEZOGEN: Biodegradierbare Schraube vs. einer Press-fit-Verankerung für VKB-Rekonstruktionen

Eine prospektive randomisierte Studie

RETRACTED: Biodegradable screw versus a press-fit bone plug fixation for ACL reconstruction

A prospective randomized study

  • Originalien
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

This article was retracted on 14 August 2014

Zusammenfassung

Hintergrund

Die Bohrkanalerweiterung und die Einheilzeit von Sehnentransplantaten sind im Vergleich zu knochengestielten Transplantaten erschwert.

Hypothese

Die Fixierung eines Sehnenpräparats mittels porösem Knochenblock vermindert die Bohrkanalerweiterung verglichen mit einer biodegradierbaren Interferenzschraube.

Methoden

Zwischen 2005 und 2006 wurden 20 Patienten (17 männlich, 3 weiblich) für eine primäre Rekonstruktion des vorderen Kreuzbandes (VKB) für die Studie rekrutiert. Die Patienten wurden für eine tibiale Fixation mit einer Interferenzschraube (I) oder einem porösen Knochenzylinder (P) randomisiert. Drei Monate postoperativ wurde ein CT-Datensatz der proximalen Tibia erstellt und die Tunnelerweiterung in koronarer und sagittaler Achse im proximalen, mittleren und distalen Drittel des Bohrkanals ermittelt. Nach 6 Monaten, 1 und 2 Jahren wurden „International Knee Documentation Committe“ (IKDC)-, Tegner- und Lysholm-Scores beider Gruppen miteinander verglichen.

Ergebnisse

Die Bohrkanalerweiterung lag in der a.-p.-Ebene für Gruppe P bei 106.9±10.9%, für Gruppe I bei 121,9±9,0% (p<0,02) und in der koronaren Ebene bei 102,8±15,2% (P) bzw. 121,5±10,1% (I; p<0,01). IKDC-, Tegner- und Lysholm-Scores verbesserten sich von prä- zu postoperativen Messungen in beiden Gruppen ohne signifikante Differenzen zwischen beiden Gruppen. Es gab in Gruppe P eine Tendenz zu höherer Kniestabilität nach 3 Monaten (0,6±1,4 vs. 1,8±1,5 mm; p=0,08).

Schlussfolgerung

Sowohl die Fixierung mittels Press-fit-Technik als auch die mit Interferenzschraube führten größtenteils zu guten bis sehr guten Ergebnissen der VKB-Rekonstruktionen. Tibiale Press-fit-Fixation verringert die proximale Bohrkanalerweiterung.

Klinische Relevanz

Die Press-fit-Fixierung verringert die proximale Bohrkanalerweiterung und verbessert den Knochen-Sehnen-Kontakt.

Abstract

Background

Press-fit fixation of a tendon graft has been advocated in order to achieve tendon to bone healing.

Hypothesis

Fixation of a tendon graft with a porous bone scaffold limits bone tunnel enlargement compared with a biodegradable interference screw fixation.

Methods

Between 2005 and 2006, 20 patients (17 men, 3 women) were enrolled in this study for primary reconstruction of the ACL. Patients were randomized to either obtain graft fixation in the tibial tunnel by means of an interference screw (I) or a press-fit fixation with a porous bone cylinder (P). Three months after surgery, a CT scan of the knee was performed and tunnel enlargement was analysed in the coronal and sagittal planes for the proximal, middle and distal thirds of the tunnel. After 6 months, 1 and 2 years, International Knee Documentation Committee (IKDC), Tegner and Lysholm scores of both groups were compared.

Results

The bone tunnel enlargement was 106.9±10.9% for group P and 121.9±9.0% for group I (P<0.02) in the AP plane and 102.8±15.2% vs 121.5±10.1% in the coronal plane (P<0.01). IKDC, Tegner, and Lysholm scores improved in both groups from pre- to postoperative assessment without significant differences between the two groups. There was a trend to higher knee stability in group P after 3 months (0.6±1.4 mm vs 1.81±.5 mm, P=0.08).

Conclusions

Both interference screw and a press-fit fixation lead to a high number of good or very good outcomes after ACL reconstruction. Tibial press-fit fixation decreases the amount of proximal bone tunnel enlargement. Press-fit fixation decreases the amount of proximal bone tunnel enlargement and improves bone to tendon contact.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Ait Si Selmi T, Fithian D, Neyret P (2006) The evolution of osteoarthritis in 103 patients with ACL reconstruction at 17 years follow-up. Knee 13(5):353–358

    Article  Google Scholar 

  2. Anderson AF, Fu F, Harner C, Vince K (1994) Rating scales: knee surgery. Williams & Wilkins, Baltimore, MD, pp 275–296

  3. Bach FD, Carlier RY, Elis JB et al (2002) Anterior cruciate ligament reconstruction with bioabsorbable polyglycolic acid interference screws: MR imaging follow-up. Radiology 225(2):541–550

    Article  PubMed  Google Scholar 

  4. Boszotta H (1997) Arthroscopic anterior cruciate ligament reconstruction using a patellar tendon graft in press-fit technique: surgical technique and follow-up. Arthroscopy 13(3):332–339

    Article  CAS  PubMed  Google Scholar 

  5. Daculsi G, Goyenvalle E, Cognet R et al (2011) Osteoconductive properties of poly(96L/4D-lactide)/beta-tricalcium phosphate in long term animal model. Biomaterials 32(12):3166–3177

    Article  CAS  PubMed  Google Scholar 

  6. Drogset JO, Grontvedt T, Myhr G (2006) Magnetic resonance imaging analysis of bioabsorbable interference screws used for fixation of bone-patellar tendon-bone autografts in endoscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 34(7):1164–1169

    Article  PubMed  Google Scholar 

  7. Fauno P, Kaalund S (2005) Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 21(11):1337–1341

    Article  PubMed  Google Scholar 

  8. Fink C, Zapp M, Benedetto KP et al (2001) Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 17(2):138–143

    Article  CAS  PubMed  Google Scholar 

  9. Freedman KB, D’Amato MJ, Nedeff DD et al (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31(1):2–11

    PubMed  Google Scholar 

  10. Fules PJ, Madhav RT, Goddard RK et al (2003) Evaluation of tibial bone tunnel enlargement using MRI scan cross-sectional area measurement after autologous hamstring tendon ACL replacement. Knee 10(1):87–91

    Article  PubMed  Google Scholar 

  11. Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC (2005) Reconstruction of the anterior cruciate ligament: meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy 21(7):791–803

    Article  PubMed  Google Scholar 

  12. Hantes ME, Mastrokalos DS, Yu J, Paessler HH (2004) The effect of early motion on tibial tunnel widening after anterior cruciate ligament replacement using hamstring tendon grafts. Arthroscopy 20(6):572–580

    Article  PubMed  Google Scholar 

  13. Hertel P, Behrend H, Cierpinski T et al (2005) ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc 13(4):248–255

    Article  CAS  PubMed  Google Scholar 

  14. Hoher J, Moller HD, Fu FH (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6(4):231–240

    Article  CAS  PubMed  Google Scholar 

  15. Howell SM, Barad SJ (1995) Knee extension and its relationship to the slope of the intercondylar roof: implications for positioning the tibial tunnel in anterior cruciate ligament reconstruction. Am J Sports Med 23(3):288–294

    Article  CAS  PubMed  Google Scholar 

  16. Howell SM, Lawhorn KW (2004) Gravity reduces the tibia when using a tibial guide that targets the intercondylar roof. Am J Sports Med 32(7):1702–1710

    Article  PubMed  Google Scholar 

  17. Jagodzinski M, Behfar V, Hurschler C et al (2004) Femoral press-fit fixation of the hamstring tendons for anterior cruciate ligament reconstruction. Am J Sports Med 32(7):1723–1730

    Article  PubMed  Google Scholar 

  18. Jagodzinski M, Breitbart A, Wehmeier M et al (2008) Influence of perfusion and cyclic compression on proliferation and differentiation of bone marrow stromal cells in 3-dimensional culture. J Biomech 41(9):1885–1891

    Article  CAS  PubMed  Google Scholar 

  19. Jagodzinski M, Foerstemann T, Mall G et al (2005) Analysis of forces of ACL reconstructions at the tunnel entrance: is tunnel enlargement a biomechanical problem? J Biomech 38(1):23–31

    Article  CAS  PubMed  Google Scholar 

  20. Jagodzinski M, Scheunemann K, Knobloch K et al (2006) Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction. Knee Surg Sports Traumatol Arthrosc 14(12):1281–1287

    Article  CAS  PubMed  Google Scholar 

  21. Jansson KA, Harilainen A, Sandelin J et al (1999) Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 7(5):290–295

    Article  CAS  PubMed  Google Scholar 

  22. 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(4):234–238

    Article  Google Scholar 

  23. Macdonald P, Arneja S (2003) Biodegradable screw presents as a loose intra-articular body after anterior cruciate ligament reconstruction. Arthroscopy 19(6):54

    Article  Google Scholar 

  24. Meyer S, Floerkemeier T, Windhagen H (2008) Histological osseointegration of Tutobone: first results in human. Arch Orthop Trauma Surg 128(6):539–544

    Article  PubMed  Google Scholar 

  25. Nebelung W, Becker R, Merkel M, Ropke M (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using Endobutton fixation on the femoral side. Arthroscopy 14(8):810–815

    Article  CAS  PubMed  Google Scholar 

  26. Noyes FR, Barber-Westin SD (2001) Revision anterior cruciate surgery with use of bone-patellar tendon-bone autogenous grafts. J Bone Joint Surg Am 83(8):1131–1143

    PubMed  Google Scholar 

  27. Paessler HH (2002) Neue Techniken in der Kniechirurgie. Steinkopff, Darmstadt

  28. Paessler HH, Mastrokalos DS (2003) Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am 34(1):49–64

    Article  PubMed  Google Scholar 

  29. Pinczewski LA, Lyman J, Salmon LJ et al (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35(4):564–574

    Article  PubMed  Google Scholar 

  30. Segawa H, Omori G, Tomita S, Koga Y (2001) Bone tunnel enlargement after anterior cruciate ligament reconstruction using hamstring tendons. Knee Surg Sports Traumatol Arthrosc 9(4):206–210

    Article  CAS  PubMed  Google Scholar 

  31. Borne MP van den, Raijmakers NJ, Vanlauwe J et al (2007) International Cartilage Repair Society (ICRS) and Oswestry macroscopic cartilage evaluation scores validated for use in Autologous Chondrocyte Implantation (ACI) and microfracture. Osteoarthritis Cartilage 15(12):1397–1402

    Article  PubMed  Google Scholar 

  32. Walsh WR, Cotton NJ, Stephens P et al (2007) Comparison of poly-L-lactide and polylactide carbonate interference screws in an ovine anterior cruciate ligament reconstruction model. Arthroscopy 23(7):757–765

    Article  PubMed  Google Scholar 

  33. Webster KE, Feller JA, Hameister KA (2001) Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 9(2):86–91

    Article  CAS  PubMed  Google Scholar 

  34. Weiler A, Hoffmann RF, Bail HJ et al (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(2):124–135

    Article  PubMed  Google Scholar 

  35. Yunes M, Richmond JC, Engels EA, Pinczewski LA (2001) Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: A meta-analysis. Arthroscopy 17(3):248–257

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Abteilung Orthopädie/Unfallchirurgie/Sportmedizin, Agnes-Karll-Krankenhaus, Laatzen, Hildesheimer Straße 158, 30880, Laatzen, Deutschland

    B. Geiges

  2. Zentrum für Radiologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    C. von Falck

  3. Klinik für Plastische, Hand- und Wiederherstellungschirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

    K. Knobloch

  4. Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Hannover, Deutschland

    C. Haasper, R. Meller, C. Krettek, S. Hankemeier & M. Jagodzinski

  5. Praxisklinik und Chirurgische Praxis Brand, Dyck und Schulz, Uelzen, Deutschland

    J. Brand

Authors
  1. B. Geiges
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. von Falck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Knobloch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Haasper
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Meller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Krettek
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. Hankemeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Brand
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Jagodzinski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Geiges.

Additional information

Der Artikel wurde von den Autoren zurückgezogen, da wesentlich Teile und Ergebnisse des Manuskripts bereits zuvor veröffentlicht wurden in

This article has been retracted by the authors because substantial parts and results of the manuscript were previously published in

Jagodzinski M, Geiges B, von Falck C, Knobloch K, Haasper C, Brand J, Hankemeier S, Krettek C, Meller R (2010) Biodegradable screw versus a press-fit bone plug fixation for hamstring anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med 38:501-508. doi: http://dx.doi.org/10.1177/0363546509350325. Epub 2009 Dec 31.

Ein Erratum zu diesem Beitrag ist unter http://dx.doi.org/10.1007/s00113-014-2597-0 zu finden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Geiges, B., von Falck, C., Knobloch, K. et al. ZURUECKGEZOGEN: Biodegradierbare Schraube vs. einer Press-fit-Verankerung für VKB-Rekonstruktionen. Unfallchirurg 116, 109–117 (2013). https://doi.org/10.1007/s00113-011-2060-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-011-2060-4

Schlüsselwörter

Keywords

Search

Navigation