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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

Press-fit fixation using autologous bone in the tibial canal causes less enlargement of bone tunnel diameter in ACL reconstruction - a CT scan analysis three months postoperatively

BMC Musculoskeletal Disorders > Ausgabe 1/2015
Ralph Akoto, Jonas Müller-Hübenthal, Maurice Balke, Malte Albers, Bertil Bouillon, Philip Helm, Marc Banerjee, Jürgen Höher
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

Jürgen Höher, Ralph Akoto and Bertil Bouillon designed the study. Jürgen Höher and Ralph Akoto directed its implementation and wrote the paper, Jürgen Höher performed the surgery. Jonas Müller-Hübenthal performed the radiological measurements. Malte Albers performed the data collection. Maurice Balke and Bertil Bouillon helped to design the study’s analytic strategy. Maurice Balke reviewed the paper. Marc Banergee and Philip Helm helped to preform the data collection and the surgery. All authors read and approved the final manuscript.



Bone tunnel enlargement is a phenomenon present in all anterior cruciate ligament (ACL)- reconstruction techniques. It was hypothesized that press-fit fixation using a free autograft bone plug reduces the overall tunnel size in the tibial tunnel.


In a prospective cohort study twelve patients who underwent primary ACL reconstruction using an autologous quadriceps tendon graft and adding a free bone block for press-fit fixation (PF) in the tibial tunnel were matched to twelve patients who underwent ACL reconstruction with a hamstring graft and interference screw fixation (IF). The diameters of the bone tunnels were analysed by a multiplanar reconstruction technique (MPR) in a CT scan three months postoperatively. Manual and instrumental laxity (Lachman test, Pivot-shift test, Rolimeter) and functional outcome scores (International Knee Documentation Committee sore, Tegner activity level) were measured after one year follow up.


In the PF group the mean bone tunnel diameter at the level of the joint entrance was not significantly enlarged. One and two centimeter distal to the bone tunnel diameter was reduced by 15 % (p = .001). In the IF group the bone tunnel at the level of the joint entrance was enlarged by 14 % (p = .001). One and two centimeter distal to the joint line the IF group showed a widening of the bone tunnel by 21 % (p < .001) One and two centimeter below the joint line the bone tunnel was smaller in the PF group when compared to the IF group (p < .001). No significant difference for laxity test and functional outcome scores could be shown.


This study demonstrates that press-fit fixation with free autologous bone plugs in the tibial tunnel results in significantly smaller diameter of the tibial tunnel compared to interference screw fixation.
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