Functional outcome of implant-free bone-patellar tendon autograft versus hamstring autograft in arthroscopic anterior cruciate ligament reconstruction: A prospective study

Abstract

Introduction The use of implant in anterior cruciate ligament (ACL) reconstruction has been associated with several drawbacks including graft injury, implant osteolysis, implant migration and soft tissue irritation. Implant-free ACL reconstruction surgery offers additional benefits of cost-effective, improved graft incorporation and ease of revision surgery. Our study aimed to compare the functional outcome of ACL reconstruction by using bone-patellar tendon autograft with press-fit fixation technique and hamstring autografts with implant. Methods A prospective cohort study design was used. Between March 2013 and March 2014, 12 patients underwent patella tendon-bone graft fixated by press-fit fixation technique (implant-free), while 24 patients underwent ACL reconstruction using implant-fixated hamstring tendon graft. Objective functional outcome was measured by using rolimeter, and subjective functional outcome was measured according to the functional score of IKDC, Tegner-Lysholm and KOOS. Results Both techniques have shown no significant difference in terms of functional outcome, whether assessed by rolimeter measurement, IKDC score, Tegner-Lysholm, KOOS score between implant group and implant-free group, preoperatively and postoperatively. Discussion Our study results are in line with several other studies with various follow-up time and systematic review. With the right technique, graft harvesting of patella tendon-tibial tuberosity bone block can be successfully performed, and associated donor site morbidity can be avoided. Conclusion Patients who underwent ACL reconstruction using implant-free technique by press-fit fixation had comparable outcome with ACL reconstruction with implant, objectively and subjectively. This technique should be further revisited and reevaluated.

Re-rupture rate and the post-surgical meniscal injury after anterior cruciate ligament reconstruction with the Press-Fit-Hybrid®-technique in comparison to the interference screw technique: a retrospective analysis of 200 patients with at least 3 years follow-up

“…The mean follow-up duration was 4 years in the PFH-group and 5 years in the IF-group, which covers the time of risk of re-rupture and was also the basis for other studies [ 23 , 43 ]. Other studies have concluded after 1 year [ 3 , 4 , 41 ] or after 2 years [ 13 , 24 , 43 ] of follow-up or even after shorter follow up time (6 months, [ 45 ]).…”

“…Appropriate indications and precise surgical techniques are crucial to ensure postoperative stability [ 18 ]. The restoration of normal knee joint kinematics reduces the risk of subsequent meniscal lesion and improves healing after meniscal refixation [ 27 , 45 ]. The most commonly used method is the interference-screw-technique, but it has been associated with risks of intra-operative graft damage and secondary graft damage caused by screw misplacement [ 41 ].…”