scholarly journals Aperture and Suspensory Fixation Equally Efficacious for Quadriceps Tendon Graft Fixation in Primary ACL Reconstruction: A Systematic Review

2019 ◽  
Vol 33 (07) ◽  
pp. 704-721
Author(s):  
Raphael J. Crum ◽  
Darren de SA ◽  
Ajay C. Kanakamedala ◽  
Obianuju A. Obioha ◽  
Bryson P. Lesniak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Graft Fixation ◽  
Fixation Method ◽  
Short Term ◽  
Knee Ligament ◽  
Suspensory Fixation ◽  
Aperture Fixation

AbstractThis review is aimed to compare suspensory and aperture quadriceps tendon autograft femoral and tibial fixations in primary anterior cruciate ligament reconstruction (ACL-R), and the clinical outcomes and complication profiles of each fixation method. Greater understanding of the optimal graft fixation technique for quadriceps tendon (QT) autografts may assist surgeons in improving outcomes after ACL-R. PubMed, Embase, and Medline were searched from database inception to September 2017, and again to July 2018, and identified 3,670 articles, 21 studies of which satisfied inclusion/exclusion criteria. Across included studies, 1,155 QT ACL-R patients (mean age, 28.7 years [range, 15–59 years], with mean postoperative follow-up of 36.1 months [range, 3.4–120 months]), were analyzed. Suspensory fixation on both sides demonstrated a higher percentage of patients (81.7%) achieving the highest rating of “A or B” on the International Knee Documentation Committee (IKDC) knee ligament examination form compared with aperture fixation on both sides (67.7%). Moreover, suspensory fixation had a lower side-to-side difference in anterior laxity (1.6 mm) when compared with aperture fixation (2.3 mm). Among studies which reported graft failure, all of which employed aperture fixation, the rate was 3.2%. Across available data, primary ACL-R using QT grafts appears to have successful short-term outcomes with a short-term graft failure rate of 3% independent of fixation method. While there is limited data regarding the comparison of aperture and suspensory soft-tissue quadriceps tendon (SQT) fixation in ACL-R, the findings of this systematic review suggest that suspensory fixation and aperture fixation in both the femoral and tibial tunnels are equally efficacious based on clinical outcome data on IKDC grade and measured laxity. This is a level IV, systematic review study.

scholarly journals Femoral Tunnel Widening Via Transcondylar Cross-Pin Fixation Versus Extracortical Suspensory Fixation After Single-Bundle ACLR: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199381
Author(s):  
Haluk Celik ◽  
Jun-Ho Kim ◽  
Sang-Hak Lee ◽  
Dae-Hee Lee
Keyword(s):  
Systematic Review ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Fixation Method ◽  
Tunnel Widening ◽  
Single Bundle ◽  
Pin Fixation ◽  
Significant Difference ◽  
Suspensory Fixation

Background: Compared with extracortical suspensory fixation, the close-to-joint transcondylar cross-pin fixation method in anterior cruciate ligament reconstruction (ACLR) is believed to entail less intratunnel graft motion and subsequently lead to less tunnel widening. Purpose: To assess femoral tunnel widening via the transcondylar cross-pin method or the suspensory femoral fixation method in patients who had undergone ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: This review focused on studies on femoral-tunnel widening after single-bundle ACLR with cross-pin (Rigidfix or Transfix) and/or Endobutton closed loop (CL). Two reviewers independently recorded data from each study, including the sample size and magnitude of tunnel widening after ACLR. Results: Overall, 19 studies were included in this meta-analysis. There was no significant difference between cross-pin and Endobutton CL fixations in the pooled absolute change in tunnel widening from the immediate postoperative period to the final follow-up; this was true at both the tunnel aperture (2.48 mm [95% CI, 1.76-3.2 mm] vs 2.93 mm [95% CI, 1.73-4.13 mm], respectively; P = .527) and the midpoint of the femoral tunnel (2.43 mm [95% CI, 1.77-3.1 mm] vs 2.54 mm [95% CI, –0.33 to 5.42 mm], respectively; P = .937). No significant difference was found in the relative percentage of femoral-tunnel widening between the 2 fixation methods (cross-pin, 43.3% [95% CI, 25.8%-60.8%] vs Endobutton CL, 42.0% [95% CI, 34.1%-49.9%]; P = .965). Conclusion: No significant difference in femoral tunnel widening was found to be associated with the use of either cross-pin or extracortical suspensory fixation in patients who underwent single-bundle ACLR.

scholarly journals Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097434
Author(s):  
Daniel F. O’Brien ◽  
Lilah Fones ◽  
Victoria Stoj ◽  
Cory Edgar ◽  
Katherine Coyner ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Sports Medicine ◽  
Cruciate Ligament ◽  
Case Series ◽  
Graft Fixation ◽  
Level Of Evidence ◽  
Lateral Cortex ◽  
Suture Button ◽  
Suspensory Fixation

Background: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design: Case series; Level of evidence, 4. Methods: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship–trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

scholarly journals Comparative study between bone patellar tendon bone and quadrupled hamstring autografts in arthroscopic anterior cruciate ligament reconstruction with aperture fixation

2017 ◽  
Vol 3 (2) ◽  
pp. 185 ◽  
Author(s):  
Dilip S. Shaktawat ◽  
Anil Kumar Mishra ◽  
Manoj R. Kashid ◽  
Amit Chaudhry ◽  
Rajshekhar . ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Cruciate Ligament ◽  
Statistical Significance ◽  
Symptomatic Improvement ◽  
Fixation Method ◽  
P Value ◽  
Significant Difference ◽  
Aperture Fixation ◽  
Anterior Cruciate ◽  
Bone Patellar Tendon

<p class="abstract"><strong>Background:</strong> Bone patellar tendon bone <strong>(</strong>BPTB) and hamstring (HT) auto grafts have been used routinely in reconstruction of ACL over past two decades. Controversy still remains as to which graft is superior over other. Many studies have compared these graft options using different implants and different methods of fixation. Continuation of efforts in the same direction; purpose of the study is to compare these two graft options utilizing identical implants and similar method of fixation.</p><p class="abstract"><strong>Methods:</strong> 40 patients of clinically and radiologically diagnosed ACL tear fulfilling the inclusion and exclusion criteria were randomized into two groups to undergo arthroscopic ACL reconstruction using quadrupled hamstring graft (n=20) and bone patellar tendon bone auto graft (n=20) utilizing bioscrew by aperture fixation method in both the groups. They were compared post operatively for symptomatic improvement, clinical and rolimeter laxity tests and Lysholm functional knee scoring at 02 year.<strong></strong></p><p class="abstract"><strong>Results:</strong> At the end of 02 years laxity measurement by rolimeter showed slightly better results in BPTB group; however it was not statistically significant (p value= 0.362). Knee pain at the end of 02 year was slightly more in HT groups (45%) as compared to BPTB group (35%) but not significant (p value =0.748). Instability symptoms are comparable in both the groups (sense of giving away on exertion). Manual laxity testing by Lachman and Pivot shift tests were comparable in both the groups with p value of 0.695 and 0.999 respectively. Lysholm functional knee score also showed no statistical significance (p value =0.957).</p><p><strong>Conclusions:</strong> There is no significant difference between HT and BPTB auto grafts in terms of clinical and functional outcome at the end of 02 years. </p>

Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year Follow-up

2019 ◽  
Vol 48 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Alexia G. Gagliardi ◽  
Patrick M. Carry ◽  
Harin B. Parikh ◽  
Jay C. Albright
Keyword(s):  
Acl Reconstruction ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Quadriceps Tendon ◽  
Acl Injuries ◽  
Patient Reported ◽  
Adolescent Patients ◽  
Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population. Purpose: To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients >2 years after primary ACL reconstruction with the QPA. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit >2 years postoperatively. Results: The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at >2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play. Conclusion: The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.

Anterior Closing Wedge Proximal Tibial Osteotomy and Revision Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft

2021 ◽  
Vol 1 (5) ◽  
pp. 263502542110227
Author(s):  
Katie Geers ◽  
Benjamin Ormseth ◽  
Andrew Garrone ◽  
Robert Siston ◽  
Robert A. Duerr
Keyword(s):  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Acl Injuries ◽  
Acl Graft ◽  
Closing Wedge ◽  
Anterior Cruciate ◽  
Tendon Autograft

Background: Anterior cruciate ligament (ACL) ruptures are among the most common injuries in young athletes and active adults. Reconstruction of the ACL most often leads to good functional outcomes and return to full activities. However, a number of patients experience ACL graft failures requiring revision surgery. The reasons for ACL graft failure are often multifactorial, though recent attention has been given to elevated posterior tibial slope (PTS) as a risk factor for recurrent ACL injuries. Indications: In patients with 2 or more ACL reconstruction failures with a PTS ≥12 degrees, anterior closing wedge proximal tibia osteotomy (ACWPTO) may be indicated to reduce the risk of recurrent ACL graft failure and allow return to full activities. Technique Description: This surgical technique video demonstrates the ACWPTO using a case example in a young athlete. Preoperative templating on lateral radiograph is used to determine the amount of correction for the closing wedge. The osteotomy is completed using K-wires and a free hand biplanar cutting technique with the tibial tubercle left in place. This is performed with a concomitant revision ACL reconstruction using quadriceps tendon autograft. Results: There are 2 small cases series published with good clinical outcomes and return to sport activities. No ACL graft failures were reported in either study with short-term follow-up. Discussion: In this surgical technique video, we review the literature indicating elevated PTS as a risk factor in ACL injuries and recurrent ACL graft failures. We highlight important technique pearls and pitfalls to avoid complications during the surgical demonstration. Finally, we review postoperative rehabilitation guidelines and clinical outcomes within the existing literature. In patients with recurrent ACL graft failures, ACWPTO provides a safe and reliable technique to correct an elevated PTS and return patients back to full activities with reduced risk of ACL graft re-tear.

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