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Comparison of fixation methods of double-bundle double-tibial tunnel ACL reconstruction and double-bundle single-tunnel technique.

ABSTRACT: An experimental study was conducted in order to evaluate biomechanical methods of single-bundle reconstruction in ACL and compare it with a new double-bundle double-tibial tunnel technique. Twenty-four porcine cadaver knees, divided into 4 groups of 6 knees each and 48 proper extensors of the fourth toe tendons, were used for the fixation techniques. In groups A and B, a double-bundle technique with a single femoral and tibial tunnel was used, fixed to a femoral and tibial post with screws and with buttons, respectively. In groups C and D, a double-bundle technique (technique Delta) with two separate tibial tunnels was used, fixed to a femoral and tibial post with screws and with buttons, respectively. A material testing system (Instron) was used for anteriorly translating the tibia until failure. The femoral and tibial post as a fixation method is superior to the conventional buttons technique. The more anatomical double-bundle reconstruction technique provided significantly higher structural properties and smaller loss of fixation compared with the single-bundle reconstruction technique. The comparison of the two techniques gave superior results to the femoral and tibial screws over the buttons. The double-bundle technique attempts to restore the anterior stability of the knee joint.

SUBMITTER: Papachristou G

PROVIDER: S-EPMC2532280 | biostudies-other | 2008 Aug

REPOSITORIES: biostudies-other

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Project description:Concomitant medial meniscus posterior horn root tears and lateral meniscus posterior horn root tears are rare in occurrence. There is limited literature on the simultaneous repair of medial and lateral meniscus root tears, with ACL reconstruction. We discuss management of concomitant medial meniscus posterior horn root tear (MMPHRT), lateral meniscus posterior horn root tear (LMPHRT), and anterior cruciate ligament (ACL) tear. We highlight the surgical technique in which we perform a repair of both medial and lateral meniscus posterior horn root repairs with ACL reconstruction. We explain the sequence of such a repair to avoid tunnel coalescence. Technique Video Video 1 The patient is in the supine position with the knee in near extension with valgus stress applied. Pie crusting of the medial collateral ligament is performed to improve the visualization of the medial meniscus posterior horn root (MMPHR) tear. FiberTape (Arthrex, Naples, FL) and FiberWire 2-0 (Arthrex) are passed through the remnant of the medial meniscus root using an antegrade suture passing device; Firstpass Mini (Smith & Nephew, London UK). The tape and sutures are passed with an antegrade suture passer, working from the anteromedial portal and visualizing from the anterolateral portal. The footprint for the MMPHR is prepared, and a guide wire is passed using a low-profile jig set at 50°. The MMPHR tunnel is reamed with a 4.5-mm reamer. The suture and tape passed through the MMPHR are shuttled out and pulled out through the tibia tunnel. With the MMPHR reduced, three all-inside devices; Fastfix 360 (Smith & Nephew) are used to repair the complex horizontal meniscus tear and the posteromedial junction radial tear. These stitches—two to the posterior capsule and the third to the posteromedial capsule—helps to reinforce the medial meniscus to the posterior capsule. We then proceed to do the LMPHRT repair. In a figure-of-four positions, lateral meniscus posterior root tear is visualized. The footprint of the lateral meniscus root is prepared. FiberTape (Arthrex) and FibreWire 2-0 (Arthrex) are passed through the remnant of the lateral meniscus root using an antegrade suture passing device; Firstpass Mini (Smith & Nephew). The FiberTape is introduced through the anteromedial portal and the FiberWire is also introduced through the anteromedial portal (Fig 3C). This is to obtain the best trajectory to pass the suture through good meniscus tissue. A guide wire is inserted at the footprint of the LMPHR using a low-profile jig set at 50°. The LMPHR tunnel is reamed using a 4.5-mm reamer. The FiberTape and the FiberWire pulled out through the LMPHR tunnel. This is followed by ACL reconstruction and passage of ACL graft. The orientation of the tunnel in the proximal tibia from medial to lateral are the MMPHR tunnel, LMPHR tunnel, and ACL tunnel. The medial and lateral meniscus roots are tensioned individually and tied over the cortical button, following which, the ACL graft is fixed with a tibial interference screw.

Project description:BackgroundTibial aperture fixation with a bioabsorbable interference screw is a popular fixation method in anterior cruciate ligament reconstruction (ACLR). An interference screw containing β-tricalcium phosphate (β-TCP) to improve bony integration and biocompatibility was recently introduced. This study aims to compare the clinical outcomes and radiological results of tunnel enlargement effect between the 2 bioabsorbable fixative devices of pure poly-L-lactic acid (PLLA) interference screws and β-TCP-containing screws, for tibial interference fixation in ACLR using hamstring autografts.MethodsEighty consecutive patients who had undergone double-bundle ACLR between 2011 to 2012 were prospectively reviewed and randomly divided into two groups based on the type of tibial interference screw: 28 were assigned to the pure PLLA screw group (Group A), while the other 29 were assigned to the β-TCP-containing screw fixation group (Group B). Clinical evaluations and radiological analyses were conducted in both groups with a minimum 2- year follow-up.ResultsThere was no significant difference in subjective or objective clinical outcome between the 2 groups. In radiological analyses, the use of a β-TCP-containing screw reduced tunnel widening in the portion of the tunnel with screw engagement compared to the pure PLLA screw, while the use of a β-TCP-containing screw resulted in greater tunnel enlargement in the proximal portion of the tunnel without screw engagement than use of a pure PLLA screw.ConclusionUse of a β-TCP-containing interference screw in tibial aperture fixation reduced tunnel enlargement in the vicinity of the screw, whereas greater enlargement occurred proximal to the screw end relative to use of a pure PLLA interference screw. These paradoxical enlargements in use of β-TCP containing screws suggest that for reducing tunnel enlargement, the length of the interference screw should be as fit as possible with tunnel length in terms of using soft grafts.Level of evidenceII, Prospectively comparative study.Trial registrationRetrospectively registered with ClinicalTrials.gov. (NCT02754674) , Date of trial registration: February 10, 2016.

Project description:BackgroundIndependent transtibial pullout repair is a common surgical technique for repairing lateral meniscus posterior root tears (LMPRTs). The shared anterior cruciate ligament (ACL) bone tunnel technique is an alternative technique for LMPRT repair combined with ACL reconstruction (ACLR) to avoid the establishment of additional bone tunnels.PurposeTo compare the clinical outcomes of the shared ACL bone tunnel versus the independent transtibial pullout techniques for LMPRT repair combined with ACLR.Study designCohort study; Level of evidence, 3.MethodsBetween March 2014 and February 2018, a total of 48 patients were diagnosed with ACL injury with concomitant LMPRT; 22 patients underwent independent transtibial pullout repair (group T), and 26 patients underwent the shared ACL bone tunnel technique (group S). At a follow-up of >2 years, we compared knee functional recovery using the Lysholm, Tegner, and International Knee Documentation Committee scores and the pivot-shift test. Lateral meniscal extrusion, and cartilage degeneration on magnetic resonance imaging (MRI) scans were also compared. The healing status of the lateral meniscus posterior root was compared using second-look arthroscopy and MRI.ResultsThe duration of surgery was significantly shorter in group S compared with group T (98.3 ± 11.1 vs 127.9 ± 17.5 min; P = .001). At final follow-up, there were no significant differences between the 2 groups in knee functional scores, pivot shift, or grade of cartilage degeneration. Lateral meniscal extrusion was decreased in group S compared with group T (2.41 ± 0.61 vs 1.59 ± 1.35 mm; P = .014). Second-look arthroscopy revealed stable healing in 16 of 18 patients (88.9%) in group S and 10 of 15 patients (66.7%) in group T (P = .38).ConclusionBoth the shared ACL bone tunnel and the independent transtibial pullout techniques led to satisfactory clinical outcomes. The shared ACL bone tunnel technique is the simpler of the 2 procedures for combined LMPRT repair with ACLR.

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Comparison of fixation methods of double-bundle double-tibial tunnel ACL reconstruction and double-bundle single-tunnel technique.

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