ACL graft with extra-cortical fixation rotates around the femoral tunnel aperture during knee flexion

Zhu, Junjun; Marshall, Brandon D. L.; Tang, Xin; Linde, Monica A.; Fu, Freddie H.; Smolinski, Patrick

doi:10.1007/s00167-021-06703-8

Cited by 17 publications

(9 citation statements)

References 39 publications

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“…It has been reported that during knee joint flexion and extension, the force exerted on the graft mainly produces two effects, namely the “bungee effect” and “windshield-wiper effect” [ 41 ]. The former is described as the longitudinal movement of the implant in the bone tunnel after ACLR, while the latter is a transverse movement relative to the bone tunnel [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

et al. 2023

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Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences in postoperative tunnel enlargement rates (TER) and clinical results between anterior and posterior tibial interference screw insertion during single-bundle ACLR using autologous hamstring grafts. Materials and Methods: A group of consecutive patients that underwent primary arthroscopic single-bundle ACLR in our hospital were screened and divided into two groups based on the position of the tibial interference screw (determined by Computer Tomography within 3 days after surgery): anterior screw position group (A) and posterior screw position group (B). The bone tunnel size was measured using magnetic resonance imaging (MRI) performed 1 year after surgery. International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for clinical results 1 year postoperatively. Results: 87 patients were included. The TER of Group A is higher than that of Group B (43.17% vs. 33.80%, p = 0.024). Group A showed a significant increase (12.1%) in enlargement rates at the joint line level than group B (43.77% vs. 31.67%, p = 0.004). Moreover, KOOS and IKDC scores improved in both groups. There were no significant differences in clinical outcomes between the two groups. Conclusions: One year after ACLR, patients with posterior screw showed significantly lower TE than patients with anterior screw. However, the position of screw did not lead to differences in clinical results over our follow-up period. Posterior screw position in the tibial tunnel maybe a better choice in terms of reducing TE. Whether the different screw positions affect the long-term TE and long-term clinical outcomes needs to be confirmed by further studies.

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Section: Discussionmentioning

confidence: 99%

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

et al. 2023

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“…A study showed that the ultimate failure load of graft was reduced by approximately 25% due to graft laceration by the interference screw 28 . Suspensory fixation allows for circumferential tendon‐bone contact, but its fixation point far away from the joint line can produce a “bungee effect” and a “windshield wiper effect” with cyclic loading 29–31 . Trans‐tunnel (i.e., RigidFix cross pins) could avoid eccentric fixation and graft injury caused by interference screws, also avoiding the “bungee effect” and “windshield wiper effect” caused by suspensory fixation, which is conducive to graft‐bone incorporation.…”

Section: Discussionmentioning

confidence: 99%

“…28 Suspensory fixation allows for circumferential tendon-bone contact, but its fixation point far away from the joint line can produce a "bungee effect" and a "windshield wiper effect" with cyclic loading. [29][30][31] Transtunnel (i.e., RigidFix cross pins) could avoid eccentric fixation and graft injury caused by interference screws, also avoiding the "bungee effect" and "windshield wiper effect" caused by suspensory fixation, which is conducive to graftbone incorporation. Thus, the trans-tunnel method seems to have advantages over the other two in theory.…”

Section: Graft Fixation Stylementioning

confidence: 99%

Outcomes of RigidFix Cross Pin Fixation in Femoral and Tibial Tunnel for Anterior Cruciate Ligament Reconstruction

Yuan,

Qi,

et al. 2023

Orthopaedic Surgery

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ObjectivesThere is no clear consensus so far on which fixation method is most favorable for the tibial tunnel in anterior cruciate ligament reconstruction (ACLR). The purpose of this paper is to investigate the outcome of RigidFix cross pins fixation in the tibial tunnel and to explore the advantages of RigidFix applied both in the femoral and tibial tunnel with hamstring tendon graft in anterior cruciate ligament reconstruction.MethodsThis retrospective study included 53 patients (male/female, 45/8) who underwent anterior cruciate ligament reconstruction using autologous hamstring tendons between January 2013 and December 2017 at our institute. The participants in group A (n = 36) received anterior cruciate ligament reconstruction with RigidFix cross pins fixation in both femoral and tibial tunnels, while those in group B (n = 17) with RigidFix cross pins fixation in the femoral tunnel and Interference screw fixation in the tibial tunnel. The visual analogue scale (VAS) score, International Knee Documentation Committee subjective knee form 2000 (IKDC2000) score, Lysholm knee scoring scale, Tegner activity score and the side‐to‐side difference were compared at 2 and 5 years postoperatively. The graft diameter, number of strands in graft and the average diameter of each strand were also compared between the two groups. The categorical parameters were analyzed by chi‐square test and the continuous variables conforming to a normal distribution were analyzed by Student's t‐test.ResultsAt 2 years postoperation, the VAS score (1.61 ± 0.55), side‐to‐side difference (1.50 ± 0.58) in group A were significantly lower than that in group B, and the IKDC2000 score (88.81 ± 3.88), Tegner activity score (6.14 ± 0.60) in group A were significantly higher than that in group B. At 5 years postoperation, the VAS score (1.64 ± 0.68), side‐to‐side difference (1.73 ± 0.63) in group A were significantly lower than that in group B, and the IKDC2000 score (89.09 ± 3.85), Tegner activity score (6.58 ± 0.94) in group A were slso significantly higher than that in group B. There was statistical difference in the change of the side‐to‐side difference between the two groups (group A vs. B, 0.22 ± 0.08 vs. 0.34 ± 0.11, p < 0.001). There were also statistical differences in the graft diameter (group A vs. B, 7.83 ± 0.74 vs. 7.41 ± 0.51, p = 0,038), number of strands in graft (5.67 ± 0.72 vs. 4.00 ± 0.00, p < 0.001) and the average diameter of each strand (1.41 ± 0.22 vs. 1.85 ± 0.13, p < 0.001) between the two groups.ConclusionRigidFix cross pins fixation in the tibial tunnel for anterior cruciate ligament reconstruction can achieve better 5‐year results when compared with the interference screw, and the hamstring tendon can be folded into a thicker graft when RigidFix cross pins were applied in both femoral and tibial tunnels.

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“…After ensuring that all intra-articular structures were intact, an ACL resection and anatomic single-bundle ACL-R were performed arthroscopically. 10,27,30,43 The ACL was transected using a punch and motorized shaver. The femoral tunnel was drilled in the center of the ACL footprint using a 10-mm cannulated femoral drill (Acufex; Smith & Nephew Inc) via the transportal technique.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Lateral Extra-articular Tenodesis in an ACL-Reconstructed Knee With Partial Medial Meniscectomy: A Biomechanical Study

Özbek,

Runer,

Dadoo

et al. 2023

Am J Sports Med

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Background: Knee laxity increases with medial meniscectomy in anterior cruciate ligament (ACL)–reconstructed knees; however, the biomechanical effect of an additional lateral extra-articular tenodesis (LET) is unknown. Purpose/Hypothesis: The purpose of this study was to determine the kinematic effect of a LET in knees that underwent combined ACL reconstruction (ACL-R) and partial medial meniscus posterior horn (MMPH) meniscectomy. It was hypothesized that the addition of LET would reduce laxity in the ACL-reconstructed knee. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen human cadaveric knees (mean age, 41.5 years) were tested using a robotic system under 3 loads: (1) 89.0 N of anterior tibial (AT) load, (2) 5 N·m of internal rotation (IR) tibial torque, and (3) a simulated pivot shift—a combined valgus of 7 N·m and IR torque of 5 N·m—at 0°, 15°, 30°, 45°, 60°, and 90° of knee flexion. Kinematic data were acquired in 4 states: (1) intact, (2) ACL-R, (3) ACL-R + partial MMPH meniscectomy (MMPH), and (4) ACL-R + partial MMPH meniscectomy + LET (MMPH+LET). Results: In response to AT loading, there was a significant increase seen in AT translation (ATT) in the MMPH state at all knee flexion angles compared with the ACL-R state, with the highest increase at 90° of knee flexion (mean difference, 3.1 mm) ( P < .001). Although there was a significant decrease in ATT at 15° of knee flexion with MMPH+LET ( P = .022), no significant differences were found at other knee flexion angles ( P > .05). In MMPH with IR torque, a significant increase was observed in IR at all knee flexion angles except 90° compared with the ACL-R state (range, 2.8°-4.9°), and this increase was significantly decreased at all flexion angles with the addition of LET (range, 0.7°-1.6°) ( P < .05). Conclusion: Performing a partial MMPH meniscectomy increased ATT and IR in response to AT and IR loads compared with the isolated ACL-R state in a cadaveric model. However, when the LET procedure was performed after partial MMPH meniscectomy, a significant decrease was seen at all knee flexion angles except 90° in response to IR and torque, and a significant decrease was seen at 15° of knee flexion in response to AT load. Clinical Relevance: LET may be a useful adjunct procedure after ACL-R with partial MMPH meniscectomy to reduce knee laxity.

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ACL graft with extra-cortical fixation rotates around the femoral tunnel aperture during knee flexion

Cited by 17 publications

References 39 publications

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

Outcomes of RigidFix Cross Pin Fixation in Femoral and Tibial Tunnel for Anterior Cruciate Ligament Reconstruction

The Effect of Lateral Extra-articular Tenodesis in an ACL-Reconstructed Knee With Partial Medial Meniscectomy: A Biomechanical Study

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