Hybrid Tibia Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction

Balazs, George C.; Brelin, Alaina M.; Grimm, Patrick D.; Dickens, Jonathan; Keblish, David J.; Rue, John-Paul

doi:10.1177/0363546515621541

Cited by 26 publications

(39 citation statements)

References 49 publications

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“…Primary stability of aperture fixation in this group was equal to primary ACL-R (n.s.) and correspondingly did not differ from primary stability of native ACL-R found in the literature [16,19,21,22].…”

Section: Discussionsupporting

confidence: 44%

“…Primary stability of tibial of soft tissue graft fixation with an IFS has been assessed in several biomechanical studies; ultimate strength has shown to be between 360 and 1200 N in biomechanical testing, with graft slippage between the IFS and the bony tunnel being the typical mode of failure [16][17][18][19][20][21]. Maximum load of IFS fixation has proven to be dependent on bone density, screw length and ratio of screw-tunnel-diameter [16][17][18][19][20][21]. Furthermore, it has been shown that primary stability of tibial IFS fixation is inferior in the revision setting after ACL-R, when a preexisting semi-anatomical tunnel or a tibial tunnel widening is present [16].…”

Section: Discussionmentioning

confidence: 99%

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Primary stability of single-stage revision reconstruction of the anterior cruciate ligament in case of failure of dynamic intraligamentary stabilization depends on implant position during ACL repair

Glasbrenner

Fischer

Raschke

et al. 2021

Arch Orthop Trauma Surg

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Introduction The object of this study was to evaluate the primary stability of tibial interference screw (IFS) fixation in single-stage revision surgery of the anterior cruciate ligament (ACL) in the case of recurrent instability after ACL repair with dynamic intraligamentary stabilization (DIS), dependent on the implant position during DIS. Materials and methods Tibial aperture fixation in ACL reconstruction (ACL-R) was performed in a porcine knee model using an IFS. Native ACL-R was performed in the control group (n = 15). In the intervention groups DIS and subsequent implant removal were performed prior to single-stage revision ACL-R. A distance of 20 mm in group R-DIS1 (n = 15) and 5 mm in group R-DIS2 (n = 15) was left between the joint line and the implant during DIS. Specimens were mounted in a material-testing machine and load-to-failure was applied in a worst-case-scenario. Results Load to failure was 454 ± 111 N in the R-DIS1 group, 154 ± 71 N in the R-DIS2 group and 405 ± 105 N in the primary ACL-R group. Load-to-failure, stiffness and elongation of the group R-DIS2 were significantly inferior in comparison to R-DIS1 and ACL-R respectively (p < 0.001). No significant difference was found between load-to-failure, stiffness and elongation of R-DIS1 and the control group. Conclusion Primary stability of tibial aperture fixation in single-stage revision ACL-R in case of recurrent instability after DIS depends on monobloc position during ACL repair. Primary stability is comparable to aperture fixation in primary ACL-R, if a bone stock of 20 mm is left between the monobloc and the tibial joint line during the initial procedure.

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Section: Discussionsupporting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Primary stability of single-stage revision reconstruction of the anterior cruciate ligament in case of failure of dynamic intraligamentary stabilization depends on implant position during ACL repair

Glasbrenner

Fischer

Raschke

et al. 2021

Arch Orthop Trauma Surg

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“…No matter what the graft choice was, double fixation was routinely considered on both sides of the joint to improve fixation strength and increase stiffness of the construct. 6,10,31,42…”

Section: Discussionmentioning

confidence: 99%

Single-Stage Revision Anterior Cruciate Ligament Reconstruction: Experience With 91 Patients (40 Elite Athletes) Using an Algorithm

White¹,

Borque

Jones

et al. 2020

Am J Sports Med

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Background: The increased prevalence of anterior cruciate ligament (ACL) reconstruction has led to an increased need for revision ACL reconstructions. Despite the growing body of literature indicating that single-stage revision ACL reconstruction can yield good outcomes, there is a lack of data for determining when and how to safely perform a single-stage revision. Purpose: To assess the outcomes, graft failure rates, and return-to-play rates of a decision-making algorithm for single-stage revision ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: We reviewed a consecutive series of revision ACL reconstructions performed by the senior author between September 2009 and July 2016 with minimum 2-year follow-up. All patients were assessed, and decision making was undertaken according to the algorithm. Outcomes measured were further surgery, graft rerupture, re-revision, Tegner score, and Knee injury and Osteoarthritis Outcome Score (KOOS). For the elite athlete population, return-to-play time, duration, and level of play after surgery as compared with preinjury were also determined. Results: During this period, 93 procedures were performed in 92 patients (40 elite athletes). Two 2-stage procedures were undertaken, leaving 91 single-stage procedures (91 patients) to form the basis for further study. At a mean 4.3 years (SD, 2.2 years) after surgery, there had been 2 re-revisions (2.2%) and 2 further instances of graft failure that had not been re-revised (total graft failure rate, 4.4%). There were 17 subsequent procedures, including 6 arthroscopic partial meniscectomies, 5 removals of prominent implants, and 1 total knee arthroplasty. The mean Tegner score was 8.02 before graft rerupture and 7.1 at follow-up. At follow-up, the mean KOOS outcomes were 79.3 for Symptoms, 88.0 for Pain, 94.2 for Activities of Daily Living, 73.6 for Sport, and 68.9 for Quality of Life. Of 40 elite athletes, 35 returned to play at a mean 11.2 months (SD, 3.6 months) after surgery. Conclusion: Single-stage revision ACL reconstructions can be performed reliably in the majority of patients, with good clinical outcomes, low rerupture rates, and high-return-to play rates, even in the elite athlete population.

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“…Presence of osteoporosis or osteopenia will interfere with the interference screw fixation, which may be mediated with cortical button fixation to strong cortical bone. 2,10 Although no FHL transfer failures have been reported in the literature, the cortical button augmentation hold potential to enhance postoperative success. 16 Bone mineral density has been reported with mixed results to affect tendon transfer in the foot and ankle.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer

Neary

McClish

Khoury

et al. 2021

Foot & Ankle Orthopaedics

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Background: Flexor hallucis longus tendon transfer (FHL) with a cortical button tension slide is an innovative addition that has not been measured against traditional methods. Methods: 12 pairs (n=24) of fresh-frozen cadaveric tibia-to-toe samples were used and randomized to receive one of the operative FHL techniques. Specimens underwent bone density analysis. Biomechanical loading was applied between 20 and 60 N at 1 Hz for 100 cycles. Post–cyclic load to failure occurred at 1.25 mm/s. Cyclic displacement, structural stiffness, and ultimate load were derived from load-displacement curves. Student t tests evaluated significant effects between both FHL techniques. Linear regression analysis assessed interactions between bone density and strength of FHL technique. Results: Average tendon diameter was 5.44±0.46 mm. Average bone density was 1.06±0.08 g/cm2. Addition of a cortical button to FHL transfer did not significantly affect cyclic displacement (0.78±0.52 mm vs 0.87±0.80 mm) or structural stiffness (162.11±43.34 N/mm vs 167.57±49.19 N/mm). Cortical button addition to FHL transfer resulted in significantly increased ultimate load (343.72±68.93 N) compared with interference screw alone (255.62±77.17 N) ( P = .0002). Linear regression analyses did not reveal any significant interactions between bone density and FHL tendon transfer technique. Conclusion: Enhanced strength can be achieved with FHL tendon transfer to calcaneus using an interference screw and cortical button tension slide technique as compared to an interference screw alone. Cortical buttons in the setting of FHL tendon transfer to the calcaneus offers an additional level of support. Clinical Relevance: Operative cases presenting with poor bone quality due to osteoporosis or osteopenia could benefit from cortical button fixation during FHL transfer. Clinical studies are needed to determine if the increased construct stability conferred from the additional use of a flip button results in fewer FHL transfer failures or better clinical outcomes. Level of Evidence: Level V, Controlled Laboratory Study.

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Hybrid Tibia Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction

Abstract: PROSPERO International Prospective Register of Systematic Reviews No. 42014015464.

Cited by 26 publications

References 49 publications

Primary stability of single-stage revision reconstruction of the anterior cruciate ligament in case of failure of dynamic intraligamentary stabilization depends on implant position during ACL repair

Primary stability of single-stage revision reconstruction of the anterior cruciate ligament in case of failure of dynamic intraligamentary stabilization depends on implant position during ACL repair

Single-Stage Revision Anterior Cruciate Ligament Reconstruction: Experience With 91 Patients (40 Elite Athletes) Using an Algorithm

Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer

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