Síndrome de fricción de la cintilla iliotibial posterior a reconstrucción del ligamento cruzado anterior con pines transversos bioabsorbibles / Iliotibial band friction syndrome due to bioabsorbable pins in ACL reconstruction

Resumen: Las lesiones del ligamento cruzado anterior (LCA) hoy en día son tratadas principalmente con injerto de isquiotibiales y una amplia gama de técnicas y sistemas de fijación del LCA en busca de una menor morbilidad del paciente. Se reporta un caso de una paciente de 42 años que sufrió ruptura de LCA, tratada con reconstrucción de LCA con injerto autólogo de isquiotibiales, fijación femoral con pines transversos bioabsorbibles y fijación tibial con tornillo bioabsorbible. La paciente evolucionó con presencia de dolor en región lateral de rodilla, diagnosticado como síndrome de fricción de la banda iliotibial un año posterior a la cirugía. Se realizaron estudios de imagen que incluyeron rayos X y resonancia magnética (RM) donde se observó adecuada fijación del LCA con presencia de migración y ruptura del pin proximal bioabsorbible. Se decidió extraer el fragmento del pin bioabsrobile en un segundo tiempo quirúrgico y la paciente regresó a sus actividades cotidianas y deportivas sin dolor y con una adecuada estabilidad.

Abstract: Injuries of the anterior cruciate ligament are currently treated primarily with the use of hamstring graft with a wide range of different techniques and fixation systems for anterior cruciate ligament in reducing patient morbidity. We report the case of a female patient aged 42 that suffered an anterior cruciate ligament rupture and was treated with anterior cruciate ligament reconstruction with hamstring autograft with femoral fixation with bio-absorbable cross-pin and tibial fixation with bio-absorbable screw. The patient presented lateral knee pain that was diagnosed one year after the operation as an iliotibial band friction syndrome. Imaging studies were performed. X-rays and magnetic resonance imaging demonstrated adequate fixation of the anterior cruciate ligament with the presence of migration and rupture of the proximal bio-absorbable cross-pin. It was decided to remove the bio-absorbable cross-pin fragment in a second surgical procedure after which the patient went back to her daily activities and sports without pain and with stability stable knee.

Biomechanical performance of Bio Cross-Pin and EndoButton for ACL reconstruction at femoral side: a porcine model

Abstract Introduction The method of graft fixation is critical in anterior cruciate ligament (ACL) reconstruction surgery. Success of surgery is totally dependent on the ability of the implant to secure the graft inside the bone tunnel until complete graft integration. The principle of EndoButton is based on the cortical suspension of the graft. The Cross-Pin is based on graft expansion. The aim of this study was to evaluate the biomechanical performance of EndoButton and Bio Cross-Pin to fix the hamstring graft at femoral side of porcine knee joints and evaluate whether they are able to support of loading applied on graft during immediate post-operative tasks. Methods Fourteen ACL reconstructions were carried out in porcine femurs fixing superficial flexor tendons with Titanium EndoButton (n = 7) and with 6 × 50 mm HA/PLLA Bio Cross-Pin (n = 7). A cyclic loading test was applied with 50-250 N of tensile force at 1 Hz for 1000 cycles. The displacement was measured at 20, 100, 500 and 1000 load cycles to quantify the slippage of the graft during the test. Single-cycle load-to-failure test was performed at 50 N/mm to measure fixation strength. Results The laxity during cyclic loading and the displacement to failure during single-cycle test were lower for the Bio Cross-Pin fixation (8.21 ± 1.72 mm) than the EndoButton (11.20 ± 2.00 mm). The Bio Cross-Pin (112.22 ± 21.20 N.mm–1) was significantly stiffer than the EndoButton fixation (60.50 ±10.38 N.mm–1). There was no significant difference between Bio Cross-Pin (failure loading: 758.29 ± 188.05 N; yield loading: 713.67 ± 192.56 N) and EndoButton strength (failure loading: 672.52 ± 66.56 N; yield loading: 599.91 ± 59.64 N). Both are able to support the immediate post-operative loading applied (445 N). Conclusion The results obtained in this experiment indicate that the Bio Cross-Pin technique promote stiffer fixation during cyclic loading as compared with EndoButton. Both techniques are able to support the immediate post-operative loading applied.

Breakage of the Femoral Cross-Pin with Impending Rupture of the Popliteal Vessels after Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

Breakage of the femoral cross-pin with impending rupture of the popliteal vessels is a rare complication for femoral tunneling in anterior cruciate ligament (ACL) reconstruction. The authors experienced a case of impending rupture of the popliteal vessels following breakage of the cross-pin 16 days after primary ACL reconstruction. Impending rupture of the popliteal vessels was detected with ultrasonography following breakage of the cross-pins which caused popliteal discomfort and irritation. After removal of the broken cross-pins, previous ACL graft and interference screw with subsequent re-reconstruction of the ACL using a new allograft and interference screw, the patient showed satisfactory results and resolution of symptoms. Therefore we report on this case with a review of literature.

Opciones de tratamientos fijos sobre implantes / Options of fixed treatments over implants

Se describe las diferentes opciones de tratamiento protésico fijo sobre implantes, sea unitarios o múltiples. Se pone un especial énfasis en comparar los beneficios y desventajas de las prótesis cementadas y atornilladas en puntos específicos de los tratamientos protésicos como son la; recuperabilidad, estética, retención, pasividad y oclusión. Introduciendo a su vez una tercera opción con el sistema de Cross pin que es una combinación de ambos sistemas. Comparando los resultados de diferentes artículos científicos se llega a la conclusión de que, la elección de tratamiento debe ser elegida primariamente por el clínico, este debe conocer las limitaciones y desventajas de cada método para poder elegir una prótesis que sea la más apropiada para cada situación clínica.

The different options of fix prosthetics treatment (unique or multiples) over implants are described. There is an emphasize in comparing the benefits and disadvantages of cemented and screwed prosthetics in specific points of the treatment like; recoverability, esthetics, retention, passivity and occlusion. Introducinga third option with the system Cross pin which is a combination of both systems. Comparing results from different scientific articles we conclude that theelection of treatment must be chosen by the clinician, he must know the limitations and disadvantages of each method so he can make an appropriate electionfor each clinical situation.

ACL Reconstruction with Autologous Hamstring Tendon: Comparison of Short Term Clinical Results between Rigid-fix and PINN-ACL Cross Pin

PURPOSE: To compare the short term clinical results of anterior cruciate ligament (ACL) reconstruction with autologous hamstring tendon between Rigid-fix and PINN-ACL Cross Pin for femoral side fixation. MATERIALS AND METHODS: 127 patients who underwent arthroscopic ACL reconstruction using autologous hamstring tendon and had been followedup for over than one year were enrolled for the present study. Rigid-fix was used in 71 cases (group 1), and PINN-ACL Cross Pin was used in 56 cases (group 2). Clinical and radiological results, operation time, and perioperative complications were compared amongst the two groups. RESULTS: The International Knee Documentation Committee subjective score and Lysholm score were 94 and 95 in group 1 and 87 and 91 in group 2, with no statistical difference (p=0.892, p=0.833), respectively. However, significant difference was observed in one-leg hop test between the two groups (p=0.032). Five cases in group 1 and 40 cases in group 2 were found to be associated with perioperative complications with statistical difference (p<0.0001). CONCLUSIONS: There was no resultant difference between the employment of PINN-ACL Cross Pin and Rigid-fix as femoral graft fixation for ACL reconstruction with hamstring tendon. However, PINN-ACL Cross Pin led to complications with extensive operation times. Hence, it needs further improvement of tools for minimization of complications.

Arthroscopic ACL Reconstruction with Autologous Hamstring Tendon using Bioabsorbable Cross Pin Fixation on the Femoral Side / 대한정형외과학회잡지

PURPOSE: To evaluate clinical results after arthroscopic ACL reconstruction using hamstring autograft with 2 femoral bioabsorbable cross pins fixations. MATERIALS AND METHODS: We evaluated the results of 97 knees in 97 patients who had arthroscopic ACL reconstruction using hamstring autograft fixed with 2 femoral bioabsorbable cross pins from September 2001 to September 2002. Average follow up was 21.9 months (range: 18-32 months). Patients were evaluated by KT 1000 arthrometer test, Lysholm score, IDKC score at preoperative and follow-up examination. Second-look arthroscopy was performed in 49 knees. RESULTS: Average Lysholm score was 72.3 (range: 51-83) preoperatively and 93.1 (range: 71-99) postoperatively. At final IKDC evaluation, 59 knees were normal (A), 36 knees nearly normal (B), 2 knees abnormal (C), and severe abnormal (D) none. Mean side-to-side difference on maximum manual evaluation using KT-1000 was at 1.3 mm (range: 1-6 mm) at follow-up. 49 knees underwent arthroscopic 2nd look evaluation, of which 31 knees preserved good tension, 18 knees some laxity, graft failure or rupture is none. CONCLUSION: ACL reconstruction using four strands hamstring autograft fixed with 2 bioabsorbable cross pins on the femoral side showed good stability in 97.9% patients at mean 21.9 months follow-up, and can be considered clinically safe and useful method.

Cross Pin Femoral Fixation for Posterior Cruciate Ligament Reconstruction Using Quadruple Hamstring Tendon

PURPOSE: The purpose of this study is to introduce new fixation technique for posterior cruciate ligament (PCL) reconstruction using quadruple hamstring tendon autograft. MATERIALS AND METHODS: From September 2001 to March 2002, eight patients received PCL reconstruction using quadruple hamstring autograft for PCL injury without associated procedures for posterolateral complex injures. All femoral tunnels were fixed with cross pins and all tibial tunnels were fixed with Intrafix(Mitek , USA). Clinical assessments consisted of Lysholm knee scores, International Knee Documentation Committee(IKDC) evaluation form and manual maximal side to side difference using KT-2000 arthrometer. RESULTS: The average Lysholm knee score improved from 54 preoperatively to 89 postoperatively. At the final IKDC evaluation, 2 cases were graded as normal, 5 nearly normal, 1 abnormal. Mean side to side difference of manual maximum posterior displacement with knee in 70 degrees flexion using the KT-2000 arthrometer was 3.7mm. CONCLUSION: In PCL reconstruction using quadruple hamstring autograft, cross pins are good fixation method with high strength and stiffness.