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Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare clinical outcomes and tunnel widening following anterior cruciate ligament reconstruction (ACLR) performed with an all-inside technique (Group A) or with a bioabsorbable tibial screw and suspensory femoral fixation (Group B).

Methods

Tunnel widening was assessed using computed tomography (CT) and a previously validated analytical best fit cylinder technique at approximately 1-year following ACLR. Clinical follow-up comprised evaluation with IKDC, KSS, Tegner, Lysholm scores, and knee laxity assessment.

Results

The study population comprised 22 patients in each group with a median clinical follow-up of 24 months (range 21–27 months). The median duration between ACLR and CT was 13 months (range 12–14 months). There were no significant differences in clinical outcome measures between groups. There were no differences between groups with respect to femoral tunnel widening. However, there was a significantly larger increase in tibial tunnel widening, at the middle portion, in Group B (2.4 ± 1.5 mm) compared to Group A (0.8 ± 0.4 mm) (p = 0.027), and also at the articular portion in Group B (1.5 ± 0.8 mm) compared to Group A (0.8 ± 0.8 mm) (p = 0.027).

Conclusion

Tibial tunnel widening after ACLR using hamstring tendon autograft is significantly greater with suspensory femoral fixation and a bioabsorbable tibial interference screw when compared to an all-inside technique at a median follow-up of 2 years. The clinical relevance of this work lies in the rebuttal of concerns arising from biomechanical studies regarding the possibility of increased tunnel widening with an all-inside technique.

Level of evidence

III.

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Funding

No external funding was used.

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Authors and Affiliations

  1. Orthopaedic Unit and Kirk Kilgour Sports Injury Center, S. Andrea Hospital, University of Rome “Sapienza”, Via di Grottarossa 1035-1039, 00189, Rome, Italy

    Edoardo Monaco, Mattia Fabbri, Andrea Redler, Edoardo Gaj, Angelo De Carli & Andrea Ferretti

  2. Department of radiology, S. Andrea Hospital, University of Rome “Sapienza”, Rome, Italy

    Giuseppe Argento

  3. Southport and Ormskirk Hospitals NHS Trust, Town Lane, Southport, England, UK

    Adnan Saithna

Authors
  1. Edoardo Monaco
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  2. Mattia Fabbri
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  3. Andrea Redler
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  4. Edoardo Gaj
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  5. Angelo De Carli
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  6. Giuseppe Argento
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  7. Adnan Saithna
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  8. Andrea Ferretti
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Corresponding author

Correspondence to Edoardo Monaco.

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Conflict of interest

Edoardo Monaco, Andrea Ferretti and Angelo De Carli declares to be consultant for Arthrex.

Ethical approval

All procedure performed in the study involving humans participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Monaco, E., Fabbri, M., Redler, A. et al. Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation. Knee Surg Sports Traumatol Arthrosc 27, 2577–2584 (2019). https://doi.org/10.1007/s00167-018-5275-x

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  • DOI: https://doi.org/10.1007/s00167-018-5275-x

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