Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years Using Adjustable Suspensory Fixation in Both the Femur and Tibia: A Prospective Study

Abstract

Background:The success of anterior cruciate ligament (ACL) reconstruction requires reliable and rigid graft fixation. Cortical suspensory fixation (CSF) devices have become an acceptable alternative to interference screws for soft tissue ACL grafts. However, CSF devices have been reported to be associated with tunnel widening and increased postoperative anterior laxity compared with interference screw fixation. Adjustable CSF devices were introduced to avoid these problems but have been associated with graft lengthening and inconsistent outcomes.Purpose:To (1) report the side-to-side difference (SSD) in anterior laxity at 150 N, clinical scores, and failure rates 2 years after ACL reconstruction with 4-strand semitendinosus autografts using an adjustable CSF device and (2) determine the preoperative factors associated with clinical outcomes.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 131 patients who had undergone primary ACL reconstruction, performed with 4-strand semitendinosus grafts that were secured using Pullup adjustable-length CSF devices with femoral and tibial fixation techniques, were prospectively enrolled in this study; 34 patients were excluded because of contralateral instability or ipsilateral knee injuries that required additional surgery. This left a cohort of 97 patients who were evaluated preoperatively and at 6, 12, and 24 months. The evaluation consisted of measuring the SSD in anterior laxity and patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Lysholm scores). Regression analyses were performed to determine associations between these outcomes and 9 preoperative variables.Results:Only 2 patients could not be reached, 2 could not be evaluated because of contralateral ACL tears, and 2 had graft failure. At 2-year follow-up, the remaining 91 patients had a mean SSD in anterior laxity of 0.8 ± 1.8 mm (range, –4.2 to 5.3 mm), mean IKDC score of 87.6 ± 10.6 (range, 43.7-100.0), and mean Lysholm score of 90.8 ± 9.3 (range, 56.0-100.0). At final follow-up, compared with knees with partial ruptures, those with complete ruptures had equivalent laxity (P = .266) and Lysholm scores (P = .352) but lower IKDC scores (P = .009). Multivariable regression revealed that the IKDC score decreased with increased preoperative laxity (β = –1.35 [95% CI, –2.48 to –0.23]; P = .019).Conclusion:The novel adjustable-length CSF device produced satisfactory anterior laxity and clinical outcomes, with a failure rate of 2.1%, which compare favorably with those reported for nonadjustable CSF devices.

Outcome of Arthroscopic Anterior Cruciate Ligament Reconstruction Knee Joint Using Hamstring Autograft

“…Detailed analysis is beyond the scope of this study.In this study, postoperative instability and failure rates were low compared with other studies. 5,12,18,21,26 Postoperative laxity also remained stable at 6 months after surgery, while clinical result continued to improve as reported by patients at subsequent follow-ups. This suggests that the surgical technique and devices used in this study offers stable graft fixation and prevents lengthening of graft at later stage.…”

“…Tunnel was always centred on the native ACL foot print and 1 cm anterior to the posterior wall. 21,22 Next tibial tunnel was drilled using tip aimer ACL guide set at 55 degree and at the centre of the remnant ACL footprint. We do not debride tibial remnant of ACL.…”

Combined Anterior Cruciate Ligament Primary Repair With an Autograft Reconstruction

“…6 At the same time, we reported in 2018 good functional and clinical results for ACL reconstruction using 4 strands of semitendinosus autologous graft with both femoral and tibial cortical adjustable fixation. 7 Our technique allows redirection of the proximal end of the remnant, which is not usually healed in femoral ACL native insertions after ACL tear. The technique described in this article allows association of the advantages of these 2 techniques: to perform an ACL reconstruction with adjustable fixations and to save the remnant (Fig 4).…”

Patient-Related Risk Factors for Contralateral Anterior Cruciate Ligament (ACL) Tear after ACL Reconstruction: An Analysis of 3707 Primary ACL Reconstructions

“…The anterior cruciate ligament (ACL) is the most commonly reconstructed ligament of the knee. Modern reconstructive techniques produce reliable outcomes, with a high rate of return to pre-injury sporting activity [5, 7, 13]. While return to play is a key outcome for both patients and surgeons after ACL reconstruction (ACLR), it also places patients at increased risk for both ipsilateral graft rupture and contralateral ACL rupture.…”