Anterior cruciate ligament graft fixation

In clinical practice, soft tissue interposition may occur during femoral graft fixation. Soft tissue interposition between the lateral femoral cortex and the cortical button may affect graft tension and related longitudinal graft motion in the tunnel. We aimed to investigate the effect of soft tissue interposition on button migration and clinical outcomes in anatomical single-bundle anterior cruciate ligament reconstruction.

Eighty-four patients aged 18–40 years, who underwent anatomical single-bundle anterior cruciate ligament reconstruction with quadruple hamstring autograft were included. Patients were divided into two groups as Group 1 (n = 32) with soft tissue interposition between the cortical button and cortex, and Group 2 (n = 52) without soft tissue interposition. At the one-year follow-up visit, the anteroposterior knee stability of the patients was evaluated using the Lachman test and KT-2000 arthrometer, and rotational stability was assessed with the pivot shift test. The Lysholm knee score was used to evaluate the functional outcome of the patients. Relationship between tissue interposition and clinical outcome, and button migration was examined.

Button migration was observed in 12 patients in Group 1 (37.5%) and two patients (3.84%) in Group 2 (p < 0.001). However, no significant difference was observed between patients with and without tissue interposition or those with and without button migration regarding knee stability parameters and clinical outcome (p < 0.05).

Postoperative tissue interposition is found to be associated with cortical button migration during the follow-up. However, it does not affect the clinical outcome.

To report a case series of failures of bioabsorbable interference screws with possible identification of a novel failure mechanism.

A retrospective review of ACL reconstructions by the senior author utilizing BioComposite™ Interference Screws (Arthrex, Inc., Naples, FL) was performed. Complications related to screw placement, including fracture, breakage or bending were examined. Our rate and methods of failure were compared to those quoted in the current literature.

Eighty-seven patients of average age 23.8 years met inclusion criteria. There were eight screw failures in six patients, with femoral failure in seven and tibial failure in one. The femoral screw fractured halfway between the tip and head in five, while the head of the screw broke in one and the screw bent in another. In the case of tibial interference screw fracture, failure occurred halfway between the tip and head. The insertion device that was used was replaced after recognition of material deformation and considered a potential contributor to the breakage risk as no further screw failures have occurred since.

We demonstrate a unique failure mechanism of bio-absorbable interference screws. In each case, the reconstruction was salvaged. Regular inspection of materials and implants can ensure optimal outcomes and decrease complications intra-operatively.

Rupture of the ACL is a common sports injury often managed with ligament reconstruction. Despite relatively high success rates, ACL graft failures do occur, providing frustration for the patient and presenting a challenge for the surgeon. Fortunately our understanding of ACL anatomy, biomechanics and reconstruction has increased dramatically in recent years. The challenge with revision ACL reconstruction begins with determining the reason for failure. Poor surgical technique with improper tunnel placement has been identified in a high proportion of failed reconstructions. Unlike primary reconstructions, additional variables including bone loss, retained hardware and concomitant meniscal, chondral and/or ligamentous injury are often present and must be addressed at the time of revision. This chapter provides an algorithm for the evaluation of patients with a failed ACL graft and guideline to revision ligament reconstruction.

The procedure for repairing the posterior cruciate ligament (PCL) has a steep learning curve and entails numerous difficult steps during surgery, because of the proximity of the neurovascular bundle, difficult passage of the graft through the posterior capsule, and risk of poor tibial fixation because of the long intramedullary trajectory of the graft. The use of instruments for retrograde reaming and a new device for adjustable cortical suspensory fixation allows for a safe, reproducible all-inside double-bundle PCL reconstruction by simplifying these difficult steps. We used anterior tibial allograft or hamstring autograft together with adjustable suspensory fixation devices that allow tensioning (after fixation) of the posterolateral bundle in extension and the anteromedial bundle in flexion.

The aim of the study was to evaluate the outcomes of Arthroscopic ACL Reconstruction using Fixed suspensory device and Adjustable suspensory device for femoral side graft fixation.

We conducted a prospective study of sixty two patients with ACL deficient knees treated with arthroscopic ACL reconstruction. Consecutively patients were operated with fixed loop and adjustable loop suspensory devices for femoral side graft fixation and no randomization was done.

Functional assessment was performed with VAS score, IKDC score and Lyshom score before and after surgery with ACL reconstruction. The postoperative Lyshom score in fixed loop group and adjustable loop group was 94.23 and 94.32 respectively. The IKDC score in fixed group and adjustable group was 92.03 and 92.16 respectively. VAS in fixed loop group improved from score of 5–3, while in adjustable loop group from score of 4–3. There was significant improvement in stability of knee assessed by Lachman’s test, anterior drawer test, and Pivot shiff’s test and both methods of fixation provide stability to knee. The complications included; restriction of terminal flexion in 12 patients: 6 in each group. There was no implant breakage in both groups.

Arthroscopic ACL reconstruction using fixed loop and adjustable loop suspensory devices are equally effective fixation methods.