Prospective randomised comparison of femoral transfix versus endobutton with constant tibial fixation in hamstring tendon ACL reconstruction: a preliminary study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20173936Keywords:
ACL, Endobutton, TransfixAbstract
Background: The purpose of this study is to evaluate clinico radiological outcome of hamstring tendon ACL reconstruction using femoral Transfixation and Endobutton with identical Tibial fixation.
Methods: A Prospective randomized clinical outcome study was done from January 2002 to June 2008, a total of 132 patients with quadruple hamstring ACL reconstruction using a femoral fixation group A Endobutton (n=68; median age=27.4) and group B with Transfix (n=64; median age=26.1) and identical Tibial fixation with Biointerference screw and bone staple were studied. Patients in each group had a clinical and radiological assessment at <3, 3-12, 12-24 and >24 months after surgery.
Results: The mean Lysholm Knee score has improved significantly with time within these groups but no difference on comparison between groups. Ninety percent of all patients had functionally normal or near normal International Knee Documentation Committee (IKDC) knee ligament ratings. IKDC Subjective Knee evaluation mean score has progressively increased significantly from pre op values of 37.58 and 36.55 to about 74.51 and 75.85 in group A and group B respectively. The tibial and femoral tunnels also showed widening of about 9.64% and 7.79% in group A as compared to 7.71% and 7.27% in group B at >24 months follow-up, which was statistically insignificant. MRI done in limited patients showed good graft incorporation in both groups.
Conclusions: So keeping the tibial graft fixation constant, the two different femoral fixation methods, Endobutton and transfixation have not influenced in the clinical outcome in this short term preliminary study. But long term follow up of these is necessary to evaluate the significance of tunnel widening and its final outcome.
References
Fu FH, Schulte KR. Anterior cruciate ligament surgery. Clinical Orthop. 1996;325:19-24.
Fu FH, Bennett CH, Ma CB, Menetrey J, Lattermann C. Current trends in ACL reconstruction. Part II. Operative procedures and clinical correlations. Am J Sports Med. 2000;28:124-30.
Shelbourne KD, Gray T. Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation, a two-to-nine year follow up. Am J Sports Med. 1997;25:786-95.
Rosenberg TD, Franklin JL, Baldwin GN, Nelson KA. Extensor mechanism functions after patellar tendon graft harvest for anterior cruciate ligament reconstruction. Am J Sports Med. 1992;20:519-25.
Don J. ACL reconstruction, semitendinosus is the graft of choice. Orthopaedics 1997;20(5):396-8.
Strobel MJ, Schulz MS. ACL reconstruction with semitendinosis and gracilis tendon graft. The Orthopedist. 2002;31(8):758-69.
Rowden NJ, Sher D, Rogers GJ, Schindhlem K. Anterior cruciate ligament graft fixation. Initial comparison of patellar tendon and semitendinosus autografts in young fresh cadavers. Am J Sports Med. 1997;25:472-8.
Fahey M, Indelicato PA. Bone tunnel enlargement after ACL replacement. Am J Sports Med. 1994;22(3):410-4.
Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following anterior cruciate ligament reconstruction:A comparison hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthroscopy. 1997;5:234-8.
Muneta T, Yagishita K, Sekiya I The outcome of anterior cruciate ligament reconstruction using quadrupled semitendinosus tendon; one bundle vs. two bundle methods. ACL study group presentations. Abstracts and PowerPoint Presentations- Italy, 2004.
Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J. Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up Am J Sports Med. 2003;31(1):19-25.
Jarvela T, Kannus P, Jarvinen M. Anterior cruciate ligament reconstruction in patients with or without accompanying injuries: A re-examination of subjects 5 to 9 years after reconstruction. Arthroscopy. 2001:17(8):818-25.
Buelow JU, Siebold R, Ellermann A prospective evaluation a tunnel enlargement in ACL reconstruction with hamstring extracortical versus anterior fixation. Knee Surg Sports Traumatol Arthrosc. 2002;10(2):80-5.
Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ Tallroth K. Bone tunnel enlargement after ACL reconstruction with the hamstring autograft and Endobutton fixation technique. A clinical, radiographic and MRI study with follow up. Knee Surg Sports Traumatol Arthrosc. 1999;7(5):290-5.
Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH. Hamstring anterior cruciate ligament reconstruction:a comparison of bioabsorbable interference screw and Endobutton-post fixation Arthroscopy. 2004;20(2):122-8.
Faunoe P. Denmark Tunnel widening after ACL reconstruction is dependent on type of fixation used. A prospective randomized study comparing two different fixation methods for hamstring grafts. ACL study group presentations. Abstracts and PowerPoint Presentations Italy. 2004.
Cinar BM, Akpinar S, Hersekli MA, Uysal M, Cesur N, Pourbagher A, et al. The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Acta Orthop Traumatol Turc. 2009;43(6):515-21.
