Is fixation with a U-shaped staple necessary in anterior cruciate ligament reconstruction?

Year 2024, , 7 - 12, 15.01.2024

Oğuzhan Pekince , Fatih Doğar

https://doi.org/10.32322/jhsm.1337566

Abstract

Aims: This study aimed to compare the clinical and functional outcomes of patients who underwent anterior cruciate ligament reconstruction using a quadruple hamstring autograft with and without U-shaped staple fixation and tibial tunnel BioScrew fixation.
Methods: Patients who underwent arthroscopic anterior cruciate ligament (ACL) reconstruction by a single surgeon between August 2020 and June 2022 were retrospectively analyzed. The time to return to sports after surgery and the evaluation of preoperative and postoperative Lysholm Knee scores, International Knee Documentation Committee (IKDC) scores, VAS scores, and thigh diameters, were conducted. Statistical analysis of the study data was performed using SPSS 29.0 (IBM InCorp, USA).
Results: A total of 100 patients (77% male) who underwent arthroscopic ACL reconstruction were included in the analysis. There was no significant difference in Lysholm knee scores and IKDC scores between patients undergoing fixation with or without staples. However, VAS scores were significantly lower in the non staple group.
Conclusion: The present study found that fixation with a staple in addition to tibial BioScrew fixation of the autograft in the tibial tunnel resulted in more pain in the patients, and there was no significant difference in clinical and functional outcomes between the staple and non staple groups.

Keywords

Anterior cruciate ligament, U-shaped staple, pain, VAS

Thanks

The authors thank Enago for their assistance in manuscript translation and editing and Adnan Karaibrahimoğlu a faculty member in the Department of Biostatistics at Suleyman Demirel University Faculty of Medicine fort he statistical analysis.

References

• Risberg MA, Ekeland A. Assessment of functional tests after anterior cruciate ligament surgery. J Orthop Sports Phys Ther. 1994;19(4):212-217.
• Garrick JG. Orthopaedic knowledge update. Sports Med. 2004;3:169-181.
• Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH. Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):982-992.
• Smith PA, Stannard JP, Pfeiffer FM, Kuroki K, Bozynski CC, Cook JL. Suspensory versus interference screw fixation for arthroscopic anterior cruciate ligament reconstruction in a translational large-animal model. Arthroscopy. 2016;32(6):1086-1097.
• Houck DA, Kraeutler MJ, McCarty EC, Bravman JT. Fixed- versus adjustable-loop femoral cortical suspension devices for anterior cruciate ligament reconstruction: A systematic review and metaanalysis of biomechanical studies. Orthop J Sports Med. 2018;6(10):2325967118801762.
• Pearle AD, McAllister D, Howell SM. Rationale for strategic graft placement in anterior cruciate ligament reconstruction: I.D.E.A.L. Femoral tunnel position. Am J Orthop (Belle Mead N.J.). 2015;44(6):253-258.
• Jorge PB, Escudeiro D, Severino NR, et al. Positioning of the femoral tunnel in anterior cruciate ligament reconstruction: functional anatomical reconstruction. BMJ Open Sport Exerc Med. 2018; 4(1):e000420.
• Yamazaki S, Yasuda K, Tomita F, Minami A, Tohyama H. The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon. Knee Surg Sports Traumatol Arthrosc. 2006;14(11):1086-1093.
• Walsh MP, Wijdicks CA, Parker JB, Hapa O, LaPrade RF. A comparison between a retrograde interference screw, suture button, and combined fixation on the tibial side in an all-inside anterior cruciate ligament reconstruction: a biomechanical study in a porcine model. Am J Sports Med. 2009;37(1):160-167.
• Noyes FR, Mangine RE, Barber S. Early knee motion after open and arthroscopic anterior cruciate ligament reconstruction. Am J Sports Med. 1987;15(2):149-160.
• Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS. Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):442-448.
• Kilinc BE, Kara A, Oc Y, et al. Transtibial vs anatomical single bundle technique for anterior cruciate ligament reconstruction: a retrospective cohort study. Int J Surg. 2016;29:62-69.
• Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DN. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med. 2016;7(7):21-32.
• Ahmad CS, Gardner TR, Groh M, Arnouk J, Levine WN. Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction. Am J Sports Med. 2004; 32(3):635-640.
• Firat A, Catma F, Tunc B, et al. The attic of the femoral tunnel in anterior cruciate ligament reconstruction: a comparison of outcomes of two suspensory femoral fixation systems. Knee Surg Sports Traumatol Arthrosc. 2014;22(5):1097-1105.
• Yasuda K, Kondo E, Ichiyama H, et al. Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy. 2004;20(10):1015-1025.
• Moon DK, Yoon CH, Park JS, et al. Effect of anteromedial portal entrance drilling angle during anterior cruciate ligament reconstruction: a three-dimensional computer simulation. Yonsei Med J. 2014;55(6):1584-1591.
• Barrow AE, Pilia M, Guda T, Kadrmas WR, Burns TC. Femoral suspension devices for anterior cruciate ligament reconstruction: do adjustable loops lengthen? Am J Sports Med. 2014;42(2):343-349.
• Petre BM, Smith SD, Jansson KS, et al. Femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction: a comparative biomechanical study. Am J Sports Med. 2013;41(2):416-422.
• Mayr R, Heinrichs CH, Eichinger M, Coppola C, Schmoelz W, Attal R. Biomechanical comparison of 2 anterior cruciate ligament graft preparation techniques for tibial fixation: adjustable-length loop cortical button or interference screw. Am J Sports Med. 2015;43(6):1380-1385.
• Vaishya R, Agarwal AK, Ingole S, Vijay V. Current trends in anterior cruciate ligament reconstruction: a review. Cureus. 2015;7(11):e378.
• Hamner DL, Brown CH Jr., Steiner ME, Hecker AT, Hayes WC. Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am. 1999;81(4):549-557.
• Brand JC Jr., Pienkowski D, Steenlage E, Hamilton D, Johnson DL, Caborn DN. Interference screw fixation strength of a quadrupled hamstring tendon graft is directly related to bone mineral density and insertion torque. Am J Sports Med. 2000;28(5):705-710.
• Ayzenberg M, Arango D, Gershkovich GE, Samuel PS, Saing M. Pullout strength of a novel hybrid fixation technique (tape locking screw™) in soft-tissue ACL reconstruction: a biomechanical study in human and porcine bone. Orthop Traumatol Surg Res. 2017;103(4):591-595.
• Wang J, Fan HQ, Dai W, et al. Safety of the application of Rigidfix cross-pin system via different tibial tunnels for tibial fixation during anterior cruciate ligament reconstruction. BMC Musculoskelet Disord. 2020;21(1):736.
• Fogel H, Golz A, Burleson A, et al. A biomechanical analysis of tibial fixation methods in hamstring-graft anterior cruciate ligament reconstruction. Iowa Orthop J. 2019;39(1):141-147.
• Monaco E, Fabbri M, Redler A, et al. Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation. Knee Surg Sports Traumatol Arthrosc. 2019;27(8):2577-2584.
• Chadwick CP, Yung SH, Brett L. Stability results of hamstring anterior cruciate ligament reconstructions at 2 to 8 year follow up. Arthrosc J Arthrosc Relat Surg. 2005;21(2):138-146.
• Cansever A, Duman İ, Özden R, et al. Artroskopİk ön çapraz bağ rekonstrüksİyonunda endobutton CL ve asansör sİstemlİ zİploop teknİklerİnİn klİnİk karşilaştirilmasi. Med J Mustafa Kemal Univ. 2015;4(16):15-22.
• Peter F, Squren K. Tunnel widening after anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: A prospective randomized study. Arthroscopy. 2005;21(11): 1337-1341.
• Gobbi A, Mahajan S, Zanazzo M, et al. Patellar tendon versus quadrupled semitendinosus anterior cruciate ligament reconstruction, A prospective clinical investigation in athletes. J Arthrosc Surg. 2003;19(6):592-601.
• Cinar BM, Akpinar S, Hersekli MA, et al. The effects of two different fixation methods on femoral bone tunnel enlargement and clinical results in anterior cruciate ligament reconstruction with hamstring tendon graft. Acta Orthop Traumatol Turc. 2009;43(6):515-521.
• Mayr R, Smekal V, Koidl C, et al. ACL reconstruction with adjustable-length loop cortical button fixation results in less tibial tunnel widening compared with interference screw fixation. Knee Surg Sports Traumatol Arthrosc. 2020;28(4):1036-1044.
• Lai PJ, Wong CC, Chang WP, Liaw CK, Chen CH, Weng PW. Comparison of two different types of hybrid tibial fixations for anterior cruciate ligament reconstruction: a prospective comparative cohort study. BMC Musculoskelet Disord. 2022;23(1):1096.
• Fabbriciani C, Mulas PD, Ziranu F, Deriu L, Zarelli D, Milano G. Mechanical analysis of fixation methods for anterior cruciate ligament reconstruction with hamstring tendon graft. An experimental study in sheep knees. Knee. 2005;12(2):135-138.
• Noh JH, Kyiung HS, Yoon KH, Roh YH. Supplementary tibial fixation in anterior cruciate ligament reconstruction - direct cortical fixation using spiked washer screw vs. post-tie using washer screw. Acta Orthop Belg. 2016;82(2):358-364.