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ACL reconstruction with adjustable-length loop cortical button fixation results in less tibial tunnel widening compared with interference screw fixation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare tunnel widening and clinical outcome after anterior cruciate ligament reconstruction (ACLR) with interference screw fixation and all-inside reconstruction using button fixation.

Methods

Tunnel widening was assessed using tunnel volume and diameter measurements on computed tomography (CT) scans after surgery and 6 months and 2 years later, and compared between the two groups. The clinical outcome was assessed after 2 years with instrumented tibial anteroposterior translation measurements, hop testing and International Knee Documentation Committee (IKDC), Lysholm and Tegner activity scores.

Results

The study population at the final follow-up was 14 patients with screw fixation and 16 patients with button fixation. Tibial tunnels with screw fixation showed significantly larger increase in tunnel volume over time (P = 0.021) and larger tunnel diameters after 2 years in comparison with button fixation (P < 0.001). There were no significant differences in femoral tunnel volume changes over time or in tunnel diameters after 2 years. No significant differences were found in the clinical outcome scores.

Conclusions

All-inside ACLR using button fixation was associated with less tibial tunnel widening and smaller tunnels after 2 years in comparison with ACLR using screw fixation. The need for staged revision ACLRs may be greater with interference screws in comparison with button fixation at the tibial tunnel. The clinical outcomes in the two groups were comparable.

Level of evidence

II.

RCT: Consort NCT01755819.

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Acknowledgements

The authors are grateful to Clemens Unterwurzacher for the illustrations.

Funding

Funding for the study was received from Arthrex Inc.

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria

    Raul Mayr, Christian Koidl, Christian Coppola & Martin Eichinger

  2. AUVA Trauma Center Klagenfurt, Klagenfurt, Austria

    Vinzenz Smekal

  3. Department of Radiology, Medical University Innsbruck, Innsbruck, Austria

    Ansgar Rudisch & Christof Kranewitter

  4. Department of Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch, LKH Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria

    René Attal

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  1. Raul Mayr
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Correspondence to René Attal.

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Investigation performed at the Department of Trauma Surgery, Medical University Innsbruck, Austria.

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Mayr, R., Smekal, V., Koidl, C. et al. ACL reconstruction with adjustable-length loop cortical button fixation results in less tibial tunnel widening compared with interference screw fixation. Knee Surg Sports Traumatol Arthrosc 28, 1036–1044 (2020). https://doi.org/10.1007/s00167-019-05642-9

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