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Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to compare femoral tunnel enlargement after anterior cruciate ligament (ACL) reconstruction surgery using hamstring autograft tendons fixed by bioabsorbable femoral trans-tunnel pins with that in patients in which the graft was fixed with extracortical fixation.

Methods

Forty-three patients were randomly selected from our database and included in the study. Femoral tunnel diameter was measured by computed tomography in 20 patients who underwent ACL reconstruction via anteromedial portal technique using autologous quadruple hamstrings, fixed with two bioabsorbable trans-tunnel pins, RigidFix, on the femoral side and compared with 23 patients in whom extracortical fixation, EndoButton CL, was used. The diameter of the femoral tunnel was measured at a distance of 5 mm from the tunnel entrance and at the largest diameter along the tunnel axis. Data were compared with the diameter of the drill used during surgery. Clinical evaluation was performed using the Lysholm score, IKDC subjective score and anterior knee laxity measurements.

Results

Femoral tunnel enlargement 5 mm from the entrance and at the largest diameter was greater in the RigidFix group than the EndoButton group. There were no significant differences between the two groups regarding age, gender, post-operative Lysholm score, IKDC subjective score or knee laxity measurements.

Conclusion

The present study showed greater enlargement of the femoral bone tunnel when a bioabsorbable trans-tunnel pin system was used with the medial portal technique when compared to extracortical fixation. These findings confirm that femoral tunnel widening should be considered when RigidFix was used in ACL reconstruction by anteromedial portal technique.

Level of evidence

III.

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References

  1. Achtnich A, Stiepani H, Forkel P, Metzlaff S, Hänninen EL, Petersen W (2013) Tunnel widening after anatomic double-bundle and mid-position single-bundle anterior cruciate ligament reconstruction. Arthroscopy 29(9):1514–1524

    Article  PubMed  Google Scholar 

  2. Allen MK, Glasoe WM (2000) Metrecom measurement of navicular drops in subjects with anterior cruciate ligament. J Athl Train 35:403–406

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Arce G, Lacroze P, Previgliano J, Constanza E, Cañete M (2008) Widening the bony tunnels after anterior cruciate ligament repair. J Bone Joint Surg Br 90((SUPPL II)):281

    Google Scholar 

  4. Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med 23:694–701

    Article  CAS  PubMed  Google Scholar 

  5. Barrett GR, Papendick L, Miller C (1995) Endobutton button endoscopic fixation technique in anterior cruciate ligament reconstruction. Arthroscopy 11:340–343

    Article  CAS  PubMed  Google Scholar 

  6. Barrow AE, Pilia M, Guda T, Kadrmas WR, Burns TC (2014) Femoral suspension devices for anterior cruciate ligament reconstruction: do adjustable loops lengthen? Am J Sports Med 42(2):343–349

    Article  PubMed  Google Scholar 

  7. Basad E, Kipper A, Wüsten OA, Sturz H, Ishaque BA (2010) Comparative study after hamstring ACL plasty with RigidFix (pin fixation) and Endobutton (anchor fixation). Z Orthop Unfall 148(3):276–281

    Article  CAS  PubMed  Google Scholar 

  8. Benjaminse A, Gokeler A, Van der Schans CP (2006) Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 36:267–288

    Article  PubMed  Google Scholar 

  9. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nochols CE (2005) Treatment of anterior cruciate ligament injuries. Part I. Am J Sports Med 33:1579–1602

    Article  PubMed  Google Scholar 

  10. Biau DJ, Toumoux C, Katsahian S, Schranz PJ, Nizard RS (2006) Bone-patellar tendon-bone autograft versus hamstring autograft for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 332:995–1001

    Article  PubMed  PubMed Central  Google Scholar 

  11. Buelow J-U, Siebold R, Ellermann A (2002) A prospective evaluation of tunnel enlargement in ACL reconstruction with hamstrings: extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc 10:80–85

    Article  PubMed  Google Scholar 

  12. Chhabra A, Kline AJ, Nilles KM, Harner CD (2006) Tunnel expansion after anterior cruciate ligament reconstruction with autogenous hamstrings: a comparison of the medial portal and transtibial techniques. Arthroscopy 22:1107–1112

    Article  PubMed  Google Scholar 

  13. Choi NH, Lee JH, Son KM, Victoroff BN (2010) Tibial tunnel widening after anterior cruciate ligament reconstructions with hamstring tendons using Rigidfix femoral fixation and Intrafix tibial fixation. Knee Surg Sports Traumatol Arthrosc 18(1):92–97

    Article  PubMed  Google Scholar 

  14. Cinar BM, Hersekli MA, Cesur N, Poubargher A, Derincek A (2009) The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Zhonghua Yi Xue Za Zhi 89(29):2034–2037

    Google Scholar 

  15. Clatworthy MG, Annear P, Buelow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc 7:138–145

    Article  CAS  PubMed  Google Scholar 

  16. 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(3):444–454

    CAS  PubMed  Google Scholar 

  17. Dejour H, Deschamps G, Walch G (1984) Resultat du traitement des laxities anterieures chroniques par operation de Kenneth Jones-Lemaire. J Lyon Chir Genou 5:129–140

    Google Scholar 

  18. Ejerhed L, Kartus J, Sernert N, Köhler N, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31:19–25

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Gomes JLE, Marczyk LR (1984) Anterior cruciate reconstruction with a loop or double thickness of semitendinosus tendon. Am J Sports Med 12(3):199–203

    Article  Google Scholar 

  21. Höher J, Möller HD, Fu FH (2008) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6:231–240

    Google Scholar 

  22. Iorio R, Vadalà A, Argento G, Di Sanzo V, Ferretti A (2007) Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendon: a CT study. Int Orthop 31:49–55

    Article  PubMed  Google Scholar 

  23. Jarvela T, Moisala AS, Paakkala T, Paakkala A (2008) Tunnel enlargement after double-bundle anterior cruciate ligament reconstruction: a prospective, randomized study. Arthroscopy 24(12):1349–1357

    Article  PubMed  Google Scholar 

  24. Kobayashi M, Nakagawa Y, Suzuki T, Okudaia S, Nakamura T (2006) A retrospective review of bone tunnel enlargement after anterior cruciate ligament reconstruction with hamstring. Arthroscopy 22(10):1093–1099

    Article  PubMed  Google Scholar 

  25. 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

    Article  Google Scholar 

  26. 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(2):122–128

    Article  PubMed  Google Scholar 

  27. Marchant MH Jr, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD (2010) Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18(8):1059–1064

    Article  PubMed  Google Scholar 

  28. Moisala AS, Jarvela T, Paakkala A, Paakkala T, Kannus P, Järvinen 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(12):1080–1086

    Article  PubMed  Google Scholar 

  29. Pereira H, Correlo VM, Silva-Correia J, Oliveira JM, Reis RL, Espregueira-Mendes J (2013) Migration of “bioabsorbable” screws in ACL repair. How much do we know? A systematic review. Knee Surg Sports Traumatol Arthrosc 21(4):986–994

    Article  PubMed  Google Scholar 

  30. Petre BM, Smith SD, Jansson KS, de Meijer PP, Hackett TR, LaPrade RF, Wijdicks CA (2013) Femoral cortical fixation devices for soft tissue anterior cruciate ligament reconstruction: a comparative biomechanical study. Am J Sports Med 41(2):416–422

    Article  PubMed  Google Scholar 

  31. Sabat D, Kundu K, Arora S, Kumar V (2011) Tunnel widening after anterior cruciate ligament reconstruction: a prospective randomized computed tomography-based study comparing 2 different femoral fixation methods for hamstring graft. Arthroscopy 27:776–783

    Article  PubMed  Google Scholar 

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

    Article  CAS  Google Scholar 

  33. Steiner ME, Hecker AT, Brown CH, Hayes WC (1994) Anterior cruciate ligament graft fixation: comparison of hamstring and patellar tendon grafts. Am J Sports Med 22:240–246

    Article  CAS  PubMed  Google Scholar 

  34. Stener S, Ejerhed L, Sernet N, Laxdal G, Rostgard-Christensen Kartus J (2010) A long-term, prospective, randomized study comparing biodegradable and metal interference screw in anterior cruciate ligament reconstruction surgery: radiographic results and clinical outcome. Am J Sports Med 38:1598

    Article  PubMed  Google Scholar 

  35. To JT, Howell SM, Hull ML (1999) Contributions of femoral fixation methods to the stiffness of ACL replacements at implantation. Arthroscopy 15:379–387

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  37. Wilson TC, Kantaras A, Atay A, Johnson DC (2004) Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 32(2):543–549

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Instituto de Ortopedia e Traumatologia de Passo Fundo, Passo Fundo, RS, Brazil

    Osmar Valadao Lopes Jr., Leandro de Freitas Spinelli, Luiz Henrique Cunha Leite, Bruce Quatrin Buzzeto, Paulo Renato Fernades Saggin & André Kuhn

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  1. Osmar Valadao Lopes Jr.
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  2. Leandro de Freitas Spinelli
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  3. Luiz Henrique Cunha Leite
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Correspondence to Osmar Valadao Lopes Jr..

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Lopes, O.V., de Freitas Spinelli, L., Leite, L.H.C. et al. Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation. Knee Surg Sports Traumatol Arthrosc 25, 1591–1597 (2017). https://doi.org/10.1007/s00167-015-3888-x

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  • DOI: https://doi.org/10.1007/s00167-015-3888-x

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