Stress fractures of the femur after ACL reconstruction with transfemoral fixation

Arriaza, Rafael; Señarís, José Antonio Amado; Couceiro, Gonzalo; Aizpurúa, Jesús

doi:10.1007/s00167-006-0181-z

Cited by 18 publications

(17 citation statements)

References 9 publications

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“…3,22 Stress fracture of the medial supracondylar area of the femur after ACL reconstruction with hamstring tendons using transfemoral fixation in professional athletes has been reported previously. 1 However, there have been no reported cases of complete periprosthetic fracture along the tract created by the guide pin during transfemoral graft fixation. The fixation device is impacted into the lateral cortex to avoid prominence and soft-tissue irritation.…”

Section: Discussionmentioning

confidence: 99%

Supracondylar Femoral Fracture After Anterior Cruciate Ligament Reconstruction with Transfemoral Fixation

Jayadev¹,

Kochhar²,

Back³

et al. 2009

J Knee Surg

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Femoral fractures following anterior cruciate ligament (ACL) reconstruction are rare. These injuries often are related to increased stresses at the femoral tunnel. Hamstring tendon autograft is often used for ACL reconstruction, and transfemoral fixation is one of many graft fixation techniques with few reported complications. This article reports an atraumatic transverse supracondylar femoral fracture occurring through the transfemoral fixation tract following hamstring ACL reconstruction in a 38-year-old woman. [J Knee Surg. 2009;22:364-366.]

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Section: Discussionmentioning

confidence: 99%

Supracondylar Femoral Fracture After Anterior Cruciate Ligament Reconstruction with Transfemoral Fixation

Jayadev¹,

Kochhar²,

Back³

et al. 2009

J Knee Surg

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“…Both devices require their own respective insertion techniques and apart from missing the femoral tunnel altogether during graft placement which can occur with both devices, other devicespecific complications have occurred with the Transfix device during insertion such as broken or twisted graft-passing wires [12][13][14] . Supracondylar femur fractures have been described with the use of Transfix too though this was not encountered in our study 15,16 . We had one patient which had a broken Transfix pin which presented as subcutaneous swelling necessitating surgical removal.…”

Section: Discussionmentioning

confidence: 51%

A Comparison of Clinical Outcomes of Two Methods of Femoral Hamstring Graft Pin Fixation in Anterior Cruciate Ligament Reconstruction

Puah

Wong

Yeo

et al. 2013

Proceedings of Singapore Healthcare

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The outcome of anterior cruciate ligament (ACL) reconstruction with hamstring grafts depends on early rehabilitation and secure graft fixation. Various devices available for graft fixation at the femoral tunnel have different biomechanical properties as demonstrated on cadaveric studies. The aim of this study was to compare clinical outcomes in patients using either of two methods of transfemoral pin fixation for hamstring grafts in ACL reconstruction. Twenty-eight patients undergoing primary ACL reconstruction with hamstring autograft with either transfemoral expansion fixation (Rigidfix) or cortical-cancellous suspension (Transfix) by a single surgeon were analysed including subjective knee scores and objective measurements including range of motion and arthrometer-measured anterior translation. Transfix was used in 14 (50.0%) patients and Rigidfix was used in 14 (50.0%) patients. There was no significant difference in pre-injury Tegner activity scores, pre-operative Tegner activity scores, Lysholm scores and age or in Tegner post-operative activity scores, Lysholm scores, range of motion, Lachman and pivot scores absolute anterior translation and anterior translation compared to the nonoperated knee at two years. There was a significant improvement in Tegner (2.6 ± 2.4, p<0.00) and Lysholm (25.3 ± 21.2, p<0.00) scores at two years with no significant difference between the two groups. One patient had a broken Transfix cross-pin 13 months after surgery which presented as a subcutaneous swelling which was removed. Although the biomechanical properties of Rigidfix and Transfix differ as demonstrated in cadaveric studies, both devices had similar favourable clinical outcomes in our series.

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“… 11 Although biomechanical testing demonstrated equivalent to superior results compared with interference screw fixation, 1 various complications have also been reported. These include implant breakage, 10 intra-articular protrusion, 23 and stress fractures of the femur 5 among others. Secondary to these concerns, the use of suspensory cortical fixation has dramatically increased over the past 5 years.…”

Section: Discussionmentioning

confidence: 99%

“… 1 However, there have been numerous complications associated with its use, including implant breakage with subsequent graft laxity 10 and lateral meniscal tearing, 12 intra-articular protrusion, 23 iliotibial band friction syndrome, 24 medial-sided pin prominence, 22 and stress fractures of the femur. 5 In light of these concerns, suspensory cortical fixation was developed and has been consequently adopted by many surgeons due to its ease of use. Nevertheless, increased tunnel widening with suspensory as compared with cross-pin fixation has been noted, 6 , 9 resulting in graft loosening with 2 to 3 mm of motion during physiologic loads.…”

mentioning

confidence: 99%

Autologous Hamstring Anterior Cruciate Ligament Graft Failure Using the Anteromedial Portal Technique With Suspensory Femoral Fixation

Galdi

Reyes

Brabston

et al. 2015

Orthopaedic Journal of Sports Medicine

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Background:The anteromedial portal technique for drilling of the femoral tunnel during anterior cruciate ligament (ACL) reconstruction has been advocated by many surgeons as allowing improved access to the anatomical footprint. Furthermore, suspensory fixation of soft tissue grafts has become popularized because of complications associated with cross-pin fixation. Concerns regarding the use of both have recently arisen.Purpose:To raise awareness of the increased risk of graft failure when using the anteromedial portal technique with suspensory femoral fixation during ACL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:From November 1998 to August 2012, a total of 465 primary ACL reconstructions were performed using quadrupled hamstring autograft tendons, with drilling of the femoral tunnel performed via the transtibial portal. Graft fixation on the femur was achieved with cross-pin fixation, while interference screw fixation was used on the tibia. From September 2012 to October 2013, there were 69 reconstructions performed through an anteromedial portal. While there was no change in graft choice, a change was made to using suspensory femoral fixation. No other surgical or postoperative rehabilitation changes were made.Results:During the 14-year period in which ACL reconstructions were performed via the transtibial portal and with cross-pin fixation, 2 graft failures (0.4% failure rate) were reported. After switching to the anteromedial portal with suspensory fixation, 7 graft failures (10.1% failure rate) were reported over a 13-month period. These were 5 male and 2 female patients, with a mean age of 18.8 years—all elite athletes. The same surgical technique was used in all patients, and all patients had at least an 8 mm–diameter graft. Patients were cleared to return to sport at an average of 8.4 months postoperatively, after completing functional performance tests. Of the 7 patients, 6 sustained a rerupture of the graft within 2 weeks of returning to full competition. The final patient sustained a rerupture 10 months after being cleared to play.Conclusion:Compared with the transtibial technique with cross-pin graft fixation, there is an increased risk of graft failure when performing autologous hamstring ACL reconstructions using the anteromedial portal technique with cortical suspensory fixation.

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Stress fractures of the femur after ACL reconstruction with transfemoral fixation

Cited by 18 publications

References 9 publications

Supracondylar Femoral Fracture After Anterior Cruciate Ligament Reconstruction with Transfemoral Fixation

Supracondylar Femoral Fracture After Anterior Cruciate Ligament Reconstruction with Transfemoral Fixation

A Comparison of Clinical Outcomes of Two Methods of Femoral Hamstring Graft Pin Fixation in Anterior Cruciate Ligament Reconstruction

Autologous Hamstring Anterior Cruciate Ligament Graft Failure Using the Anteromedial Portal Technique With Suspensory Femoral Fixation

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