Comparison of Perioperative Malposition Rates of Fixed and Adjustable Suspensory Button Implants Used for Femoral Fixation During Anterior Cruciate Ligament Reconstruction

Öz

Aim: This study compared the malposition rates of fixed and adjustable suspensory button implants used for femoral fixation of the graft during anterior cruciate ligament (ACL) reconstruction and examined the effectiveness of intraoperative imaging in managing these complications. Methods: This retrospective study evaluated 187 patients who underwent arthroscopic ACL reconstruction. The patients included in the study were categorized into two groups according to the type of femoral suspensory button (FSB) implant used: fixed suspensory button (FxSB) and adjustable suspensory button (ASB). Button malpositions were determined and recorded with intraoperative images in cases where fluoroscopy was used and postoperative X-ray radiographs in cases where fluoroscopy was not used. Malposition rates were compared between the two groups, and risk analysis was performed. Results: The FxSB implant was used in 89 patients, and the ASB implant was used in 98 patients. Malposition was detected in 24 patients (12.8%). When the FxSB and ASB implant groups were analyzed separately, the number and rate of malpositions were 5 (5.6%) and 19 (19.3%), respectively (p=.0123). Regression analysis showed that the risk of malposition was 3.5 times higher in the ASB implant group than in the FxSB implant group (M: 3.57 (p=.0017) 95% CI (1.36-10.1)). Conclusion: This study found that ASB implants used in ACL reconstruction resulted in a higher rate of button malposition than FxSB implants. In addition, intraoperative fluoroscopy was found to be a useful method to detect malpositions in all FSB implants and allow for proper button positioning with intraoperative interventions.

Anahtar Kelimeler

• Keywords: ACL reconstruction
• suspensory button implant
• fluoroscopy
• malposition

Ön Çapraz Bağ Rekonstrüksiyonu Sırasında Femoral Fiksasyon İçin Kullanılan Sabit ve Ayarlanabilir Askı Düğmesi İmplantlarının Perioperatif Malpozisyon Oranlarının Karşılaştırılması

Öz

Amaç: Bu çalışmada, ön çapraz bağ (ACL) rekonstrüksiyonu sırasında greftin femoral fiksasyonu için kullanılan sabit ve ayarlanabilir askılı düğme implantlarının malpozisyon oranları karşılaştırıldı ve bu komplikasyonların yönetiminde intraoperatif görüntülemenin etkinliği incelendi. Yöntemler: Bu retrospektif çalışmada, artroskopik ACL rekonstrüksiyonu geçiren 187 hasta değerlendirildi. Çalışmaya dahil edilen hastalar, kullanılan femoral askılı düğme (FSB) implantının türüne göre iki gruba ayrıldı: sabit askılı düğme (FxSB) ve ayarlanabilir askılı düğme (ASB). Düğme malpozisyonları, floroskopi kullanılan vakalarda intraoperatif görüntülerle ve floroskopi kullanılmayan vakalarda postoperatif X-ışını radyografileriyle belirlendi ve kaydedildi. Malpozisyon oranları iki grup arasında karşılaştırıldı ve risk analizi yapıldı. Sonuçlar: FxSB implantı 89 hastada, ASB implantı ise 98 hastada kullanıldı. Malpozisyon 24 hastada (%12,8) tespit edildi. FxSB ve ASB implant grupları ayrı ayrı analiz edildiğinde, malpozisyon sayısı ve oranı sırasıyla 5 (%5,6) ve 19 (%19,3) olarak bulundu (p=.0123). Regresyon analizi, ASB implant grubunda malpozisyon riskinin FxSB implant grubuna göre 3,5 kat daha yüksek olduğunu gösterdi (M: 3.57 (p=.0017) 95% CI (1.36-10.1)). Sonuç: Bu çalışma, ACL rekonstrüksiyonunda kullanılan ASB implantlarının FxSB implantlarına göre daha yüksek oranda buton malpozisyonuna yol açtığını buldu. Ayrıca, intraoperatif floroskopinin tüm FSB implantlarında malpozisyonları tespit etmek ve intraoperatif müdahalelerle butonun uygun şekilde konumlandırılmasını sağlamak için yararlı bir yöntem olduğu bulundu.

Anahtar Kelimeler

• ACL rekonstrüksiyonu
• askılı düğme implantı
• floroskopi
• malpozisyon

Kaynakça

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