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Knee Surgery, Sports Traumatology, Arthroscopy

Erschienen in:

12.08.2020 | KNEE

Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis

verfasst von: Ajaykumar Shanmugaraj, Mathepan Mahendralingam, Chetan Gohal, Nolan Horner, Nicole Simunovic, Volker Musahl, Kristian Samuelsson, Olufemi R. Ayeni

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 6/2021

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Abstract

Purpose

Press-fit fixation is a hardware-free technique in anterior cruciate ligament reconstruction (ACLR). The purpose of this review was to quantitatively assess the risk profile and outcomes of press-fit fixation and provide an update on its effectiveness compared to more standard fixation techniques of ACLR.

Methods

The electronic databases PUBMED, MEDLINE, and EMBASE were searched on March 26, 2020 for therapeutic randomized controlled trials (RCT) addressing press-fit fixation for primary ACLR. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the quality for randomized studies. A meta-analysis with a random-effects model was used to pool applicable outcomes data.

Results

A total of six eligible RCTs were included in this review. There were 292 patients (72.9% male) with a mean age of 28.8 ± 3.8 years and a mean follow-up of 81.3 ± 88.3 months that underwent press-fit ACLR on the femoral, tibial or both tunnels. Femoral fixation techniques included press-fit fixation (96.6%) and cross-pin fixation (3.4%). Tibial fixation techniques included press-fit (37.0%), staples (28.1%), interference screws (21.2%) and abarticular post-screws (13.7%). Graft options included bone–patellar tend–-bone autografts (73.6%) and semitendinosus and gracilis tendon autograft (26.4%). Significant improvements (p < 0.05) from baseline to follow-up were found for clinical outcomes. Significantly less postoperative bone tunnel enlargement (p < 0.05) was found with tibial press-fit fixation when compared to biodegradable screws. The overall complication rate was 13.3%. There were no significant differences in complication rates [odds ratio = 0.84 (95%CI 0.43–1.66); p = n.s.] (I² = 0%) between patients undergoing femoral press-fit fixation and femoral metal interference screw fixation.

Conclusion

The overall graft failure and revision rates with press-fit ACLR were low. There were no significant differences in complication rates between patients undergoing femoral press-fit and femoral metal interference screw fixation. Included studies found that patients undergoing press-fit fixation for ACLR had significant improvements in functional outcome scores postoperatively and had significantly reduced postoperative bone tunnel enlargement compared to patients undergoing bioabsorbable fixation. Thus, early evidence suggests that press-fit fixation appears to be a good option for patients undergoing ACLR.

Level of evidence

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Titel: Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis
verfasst von: Ajaykumar Shanmugaraj
Mathepan Mahendralingam
Chetan Gohal
Nolan Horner
Nicole Simunovic
Volker Musahl
Kristian Samuelsson
Olufemi R. Ayeni
Publikationsdatum: 12.08.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 6/2021
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-020-06173-4

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Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis