Cortical Button Fixation

Ode, Gabriella E.; Piasecki, Dana P.; Habet, Nahir A.; Peindl, Richard D.

doi:10.1177/0363546516651614

Cited by 23 publications

(30 citation statements)

References 22 publications

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“…In particular, it is possible that differences in graft position within the given tunnels (ie, greater isometry for grafts pushed by the interference screws to the anterior aspect of their femoral tunnels, and increased anisometry for those pushed posteriorly on the tibia) could explain some of the anisometry findings, and this factor was not evaluated in this investigation. Recognizing that no cadaveric model can perfectly simulate the live knee, our particular model—while representing an established method of assessing ligament kinematics 3 , 28 , 29 and providing the information we sought to obtain—cannot comment on all the kinematic features of normal knee function and did not assess translational or rotational stability, as some authors have. 8 Finally, while our findings suggest HTT may represent a favorable balance between both AM portal and TT approaches, our cadaveric model only assessed the ability of the 3 tested techniques to achieve the goal tunnel position, not whether that particular position is itself ideal.…”

Section: Discussionmentioning

confidence: 99%

Transtibial Versus Anteromedial Portal ACL Reconstruction: Is a Hybrid Approach the Best?

Jennings¹,

Leas

Fleischli

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Improved biomechanical and clinical outcomes are seen when the femoral tunnels of the anterior cruciate ligament (ACL) are placed in the center of the femoral insertion. The transtibial (TT) technique has been shown to be less capable of this than an anteromedial (AM) portal approach but is more familiar to surgeons and less technically challenging. A hybrid transtibial (HTT) technique using medial portal guidance of a transtibial guide wire without knee hyperflexion may offer anatomic tunnel placement while maintaining the relative ease of a TT technique.Purpose:To evaluate the anatomic and biomechanical performance of the HTT technique compared with TT and AM approaches.Study Design:Controlled laboratory study.Methods:Thirty-six paired, fresh-frozen human knees were used. Twenty-four knees (12 pairs) underwent all 3 techniques (TT, AM, HTT) for femoral tunnel placement, with direct measurement of femoral insertional overlap and femoral tunnel length. The remaining 12 knees (6 pairs) underwent completed reconstructions to evaluate graft anisometry and tunnel orientation, with each technique performed in 4 specimens and tested using motion sensors with a quad-load induced model. Graft length changes and graft/femoral tunnel angle were measured at varying degrees of flexion.Results:Percentage overlap of the femoral insertion averaged 37.0% ± 28.6% for TT, 93.9% ± 5.6% for HTT, and 79.7% ± 7.7% for AM, with HTT significantly greater than both TT (P = .007) and AM (P = .001) approaches. Graft length change during knee flexion (anisometry) was 30.1% for HTT, 12.8% for AM, and 8.5% for TT. When compared with the TT approach, HTT constructs exhibited comparable graft–femoral tunnel angulation (TT, 150° ± 3° vs HTT, 142° ± 2.3°; P < .001) and length (TT, 42.6 ± 2.8 mm vs HTT, 38.5 ± 2.0 mm; P = .12), while AM portal tunnels were significantly shorter (31.6 ± 1.6 mm; P = .001) and more angulated (121° ± 6.5°; P < .001).Conclusion:The HTT technique avoids hyperflexion and maintains femoral tunnel orientation and length, similar to the TT technique, but simultaneously achieves anatomic graft positioning.Clinical Relevance:The HTT technique offers an anatomic alternative to an AM portal approach while maintaining the technical advantages of a traditional TT reconstruction.

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Section: Discussionmentioning

confidence: 99%

Transtibial Versus Anteromedial Portal ACL Reconstruction: Is a Hybrid Approach the Best?

Jennings¹,

Leas

Fleischli

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Aside from tendon augmentation, numerous studies have assessed in vitro strength of patellar and quadriceps tendon repairs and augmentations with various suture materials, 33 , 34 , 35 , 36 fixation devices, 37 , 38 , 39 , 40 , 41 and additional synthetic augmentation modalities. 42 In the setting of an acute KEM rupture amenable to such repair techniques, the aforementioned studies provide insight into how best to repair such injuries.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Biomechanical Outcomes following Knee Extensor Mechanism Reconstruction

Akpinar

Baron

Alaia

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To evaluate clinical and biomechanical outcomes after knee extensor mechanism reconstruction (KEMR). Methods Patients who underwent KEMR at our institution from 2011 to 2018 were identified. Patient-reported outcomes (Kujala, Lysholm, Tegner Activity Scale) were compiled at clinical follow-up. Isokinetic testing was conducted using the BioDex system 4 pro dynamometer at slow (60°/s), intermediate (180°/s), and fast (300°/s) speeds in a 9-patient subset. Results From 2011 to 2018, 12 patients (12 knees, 10 male, 5 right, mean age: 54.3 ± standard deviation: 15.2 years) with KEM injuries requiring tendon reconstruction with a 1-year minimum follow up were identified. Postoperative follow-up was 42.6 months (range: 12.0-93.0 months). Procedures included patellar (7) and quadriceps tendon reconstruction (5). Postoperative versus preoperative Tegner Activity Scale scores demonstrated significant improvement (3.5 ± 2.5 vs 1.5 ± 1.2, n = 8, P = .05). Postoperative versus preoperative Kujala scores significantly improved (70.3 ± 11.7 vs 43.6 ± 15.7, n = 8, P = .010). There was significant improvement in preoperative to postoperative KEMR extension lag (29.4 ± 22.2° vs 0.83 ± 1.9°, P = .002). Clinically, there was no difference in passive range of motion between the operative and contralateral knee. BioDex testing demonstrated decreased maximum work generated from the operative versus contralateral knee at slow (70.4 ± 30.4 Joules vs 101.9 ± 40.6 J; P = .028), intermediate (52.0 ± 45.4 J vs 69.8 ± 63.7 J; P = .038), and fast (43.8 ± 41.7 J vs 57.5 ± 53.8 J; P = .050) speeds. Range of motion was less in the operative versus contralateral knee at all speeds: P = .011, .038, and .024. The average peak torque generated per body weight was smaller in the operative versus contralateral knee at slow speed ( P = .038). Conclusions Patients undergoing KEMR in this study have significantly improved clinical outcomes despite having strength deficits that persist postoperatively. Level of Evidence Therapeutic Case Series, Level IV.

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“…Cortical suspensory fixation results in significantly less gap formation and the ability to withstand twice the load to failure when compared with transosseous tunnels or suture anchor fixation. 18 Biomechanical testing of a repair technique using a combination of transosseous sutures, suture anchors, biological augmentation, and cortical button fixation has not been performed to our knowledge. However, it is logical that this combination would provide greater resistance to strain and gap formation.…”

Section: Discussionmentioning

confidence: 99%

“…In cases of primary repair without augmentation, a period of immobilization to protect the repair from gap formation and reduce the risk of rerupture has been recommended. 18 However, prolonged immobilization has several disadvantages including development of joint stiffness, poor cartilage nutrition, and muscle atrophy. 19 The combination of transosseous sutures, suture anchors, cortical button fixation, and biological augmentation with a 4-stranded semitendinosus graft allows for more aggressive rehabilitation and reduced risk of tendon rupture.…”

Section: Discussionmentioning

confidence: 99%

Patellar Tendon Repair With Ipsilateral Semitendinosus Autograft Augmentation

Woodmass

Johnson

et al. 2017

Arthroscopy Techniques

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Patellar tendon ruptures are rare but potentially devastating injuries. Acute repair after patellar tendon rupture affords the best opportunity for tension-free restoration of the extensor mechanism. Biological augmentation of primary repair is believed to decrease strain across the repair site and reduce the risk of rerupture. We present a technique for primary patellar tendon repair with bidirectional fixation using transosseous tunnels, suture anchor fixation, and ipsilateral hamstring autograft augmentation in a distal patellar pole socket.

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Cortical Button Fixation

Abstract: The biomechanical superiority of cortical button fixation may impart clinical advantages in accelerating postoperative rehabilitation.

Cited by 23 publications

References 22 publications

Transtibial Versus Anteromedial Portal ACL Reconstruction: Is a Hybrid Approach the Best?

Transtibial Versus Anteromedial Portal ACL Reconstruction: Is a Hybrid Approach the Best?

Clinical and Biomechanical Outcomes following Knee Extensor Mechanism Reconstruction

Patellar Tendon Repair With Ipsilateral Semitendinosus Autograft Augmentation

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