Outcomes of endobutton and rigidfix femoral fixation methods with hamstring autograft in anterior Cruciate ligament reconstruction / 中国组织工程研究

BACKGROUND: The choice of fixation is an important factor affecting the prognosis of anterior cruciate ligament reconstruction. Endobutton and Rigidfix are two kinds of femoral end suspension fixators which are widely used at present. Their advantages are high fixation strength, large contact area between tendon and bone tunnel, and conducive to tendon-bone healing. However, it is still controversial whether there are differences in clinical efficacy and bone tunnel enlargement between the two fixation methods. OBJECTIVE: To analyze the outcomes of two different femoral fixation methods (Endobutton and Rigidfix) with hamstring autograft in anterior cruciate ligament reconstruction. METHODS: A retrospective analysis was performed on the data of 270 cases which accepted the anterior cruciate ligament reconstruction and second arthroscopic look from June 2015 to December 2017. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into two groups according to the method of femoral end fixation. The Endobutton femoral fixed reconstruction was performed in Endobutton group (150 cases). The Rigidfix femoral fixed reconstruction was performed in Rigidfix group (120 cases). Reconstruction of anterior cruciate ligament was done using autologous semitendinosus and gracilis tendon. All cases were fixed with Bioabsorbable Interference Screw and AO hollow nail bolt pile fixing screw at the tibial tunnel. The diameter of bone tunnel was also measured by MRI. The knee joint function recovery and stability were evaluated by Lysholm score, International Knee Documentation Committee score, Tenger score table, drawer test, Lachman test, axle shift test, and KT-1000 joint measuring instrument. Second-look arthroscopic evaluation was performed in all patients, focusing on continuity of the reconstructed anterior cruciate ligament, the synovial coverage and the prevalence of abnormal structure at 1 year after surgery. RESULTS AND CONCLUSION: (1) All patients were followed up for 14 to 44 months. (2) Tunnel widening was significantly increased in the Endobutton group than in the Rigidfix group at 1 year after surgery (P 0.05). (4) At 1 year after surgery, the range of motion of knee joint was not significantly different between the two groups (P > 0.05). (5) There was no significant difference between the two groups in drawer test, Lachman test and axle shift test (P > 0.05). The side-to-side difference of KT-1000 in the Endobutton group was (1.12±1.20) mm, while that of KT-1000 in Rigidfix group was (1.23±0.91) mm. There was no significant difference between the two groups (P > 0.05). (6) Secondary arthroscopic examination showed that there were 1 case of complete graft absorption, 11 cases of graft wear in Endobutton group, 2 cases of complete graft absorption and 15 cases of graft wear in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (7) There were 59 excellent cases, 61 good cases, 30 poor cases in Endobutton group, 47 excellent cases, 49 good cases and 24 poor cases in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (8) The incidence of complication was 2.6% in the Endobutton group and 6.6% in the Rigidfix group, and no significant difference was found between the two groups (P > 0.05). (9) The results suggested that Endobutton and Rigidfix had the same clinical outcome. There was no significant difference in the coverage and continuity of synovial synovial membrane between the second look grafts. However, compared with Rigidfix transverse screw system, Endobutton fixation at the femoral end is more likely to cause bone tunnel enlargement.

A Comparative Study of Clinical Outcomes and Second-Look Arthroscopic Findings between Remnant-Preserving Tibialis Tendon Allograft and Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Matched-Pair Design

BACKGROUND: This study aimed to compare stability, functional outcome, and second-look arthroscopic findings after anterior cruciate ligament reconstruction between remnant-preserving tibialis tendon allograft and remnant-sacrificing hamstring tendon autograft. METHODS: We matched two groups (remnant-preserving tibialis tendon allograft group and hamstring tendon autograft group) in terms of demographic characteristics, associated injury, and knee characteristics. Each group consisted of 25 patients. RESULTS: Operation time was longer in the remnant-preserving tibialis tendon allograft group, but there was no significant intergroup difference in stability, clinical outcome, and second-look arthroscopic findings. CONCLUSIONS: When an autograft is not feasible in anterior cruciate ligament reconstruction, the remnant-preserving technique can produce comparable results in terms of restoration of function, stability of the knee, and degree of synovium coverage at second-look arthroscopy compared to remnant-sacrificing hamstring autograft.

Effect of single bundle anatomic reconstruction of the anterior cruciate ligament with the hamstring autograft through anteromedial approach / 中国内镜杂志

Objective To investigate the effect of single bundle anatomic reconstruction of the anterior cruciate ligament (ACL) with the hamstring autograft through anteromedial approach. Methods From January 2012 to Jan-uary 2014, 39 patients with ACL tore had been treated with single bundle anatomic ACL reconstruction with the hamstring autograft. In this group, 20 males and 19 females, 16 cases of the left knee and 23 cases of the right knee;including 27 cases of sports injuries, 5 cases of traffic accident injury and 7 cases of fall injury.8 cases were acute injury the others were old injury. 22 cases were had the meniscus injury. All patients were treated with single bundle anatomic ACL reconstruction with the hamstring autograft. The femoral tunnel was establish through the anteromedial approach. The medial meniscus suture was performed in 10 cases, partial resection in 2 cases, lateral meniscus su-ture in 9 cases, partial resection in 1 cases. The hamstring autograft was fixed with the RIGFIX system in the femoral tunnel and the BIOSURE SYNC in the tibia tunnel. The Lysholm score was used to evaluate the recovery of knee function, and the MRI score was used to evaluate the integraty of the grafts. Results All cases were followedup for 15 to 39 months with an average of 21.5 months. All cases had no vascular nerve injury, joint stiffness, infec-tion and other complications. All cases had good stability after 1 year and recover to normal sports after six months and intense sports after half past a year postoperation. The anterior drawer test and the Pivot shift tests were negative in all patients. The Lacheman test wasⅠin 1 patient and others were negative. The mean Lysholm score was (93.85± 4.33) which significantly increased compared with preoperative scores which was (36.84 ± 5.60) after 15 months (P <0.05). The MRI showed good maturity and normal morphology of the ACL autograft, the MRI score was (9.80 ±1.70) after 1 year postoperation. Conclusion The arthroscopic single bundle individual anatomic ACL reconstruction with hamstring autograft through anteromedial approach is effective, simple to perform and gives a graft the same as nor-mal anatomy. The grafts revascularization is good and effectively restore the stability of the knee.

Correlation between Hamstring Flexor Power Restoration and Functional Performance Test: 2-Year Follow-Up after ACL Reconstruction Using Hamstring Autograft

PURPOSE: To evaluate the restoration of the flexor power and the correlation between the flexor power and functional performance tests (FPTs) after anterior cruciate ligament (ACL) reconstruction with hamstring autograft. MATERIALS AND METHODS: Twenty-three men, who underwent ACL reconstruction with hamstring autograft, were evaluated using Lysholm, Subjective IKDC, Tegner activity score, isokinetic flexion and hyperflexion power test, and the FPTs at 1 and 2-year follow-up. We analyzed the mean change from 1 to 2 year and the correlation between both the flexion and hyperflexion power deficit with the FPTs at each follow-up. RESULTS: Mean age of the patients was 30.9 years (range, 19 to 44). Tegner activity score was significantly increased from 5.7 to 6.3 (p=.010). Hyperflexion power of the involved knee deficits significantly decreased at 2 year follow-up compared with 1 year (p<.001). There was a correlation between the flexor power deficit and the co-contraction, carioca, and involved one-legged hop test at each follow-up. However, no significant correlations were revealed between the hyperflexion power deficit and the FPTs. CONCLUSIONS: Hyperflexion power deficit after ACL reconstruction with the hamstring autograft decreased at 2 year follow-up compared to 1 year and does not affect the results of the FPTs.

Comparison of the Suspensory and Double Cross-pin Graft Fixation after ACL Reconstruction Using Hamstring Autograft / 中国运动医学杂志

Objective To compare the clinical results of Endobutton and Rigidfix graft fixation at the femoral tunnel after ACL reconstruction with hamstring autografts.Methods 48 patients accepting ACL reconstruction with hamstring autografts were retrospective studied.According to different fixation adopted at the femoral tunnel,they were divided into group A(24 patients,with Rigidfix cross pin)and group B(24 patients,with Endobuaon).All Cases were fixed with Intrafix interference screw and Spiked Washer screw at the tibial tunnel.The average follow-up time was 27 months.KT-1000 arthrometric measurement and the IKDC,Lysholm,Tegner scores were used for evaluation.The diameter of bone tunnel was also measured by MRI.Results Tunnel widening were found in both groups,but the increase of both the femoral and tibial tunnels in group B were significantly greater than group(P<0.05).In both groups after operation,there was significantly increases of IKDC suhjective scores,Lysholm scores,Tegner scores and KT-1000 results also had obviously improvement(P<0.05).But no significant difference was found between two groups after operation.Conclusion Compared with double cross-pins for fixation at the femoral tunnel,tunnel widening was more prone to happen when using Endobutton suspensory fixation system.

Comparison of the Outcomes on Second-Look Arthroscopy after Anterior Cruciate Ligament Reconstruction Using a Hamstring Autograft or a Tibialis Anterior Allograft

PURPOSE: We wanted to evaluate the status and changes of the reconstructed anterior cruciate ligament (ACL) graft by performing second-look arthroscopy after arthroscopic reconstruction of the ACL with a hamstring autograft or a tibialis allograft. MATERIALS AND METHODS: From June 2003 to February 2007, second look arthroscopy was performed on 58 cases and a hamstring autograft was used in 36 cases and a tibialis allograft was used in 22 cases. Second-look arthroscopy was conducted at an average of 19.1 (12~42) months after reconstruction. We measured the graft tension using displacement by probing and the synovial coverage by visual analysis at the time of second-look arthroscopy. The Lysholm score, the Lachman test and a KT-2000 arthrometer were used to evaluate the status of the reconstructed ACL. RESULTS: The hamstring tendon autograft group showed normal tension in 25 cases, lax tension in 7 cases and partial tear in 4 cases. The tibialis anterior allograft group showed normal tension in 12 cases, lax tension in 5 cases and partial tear in 5 cases. In the hamstring tendon autograft group, the synovial coverage was good in 23 cases, there was half coverage in 8 cases and it was pale in 5 cases. In the tibialis anterior allograft group, the synovial coverage was good in 10 cases, there was half in 7 cases and it was pale in 5 cases. There were no significant differences between the two groups on the clinical examination, but on second look arthroscopy, the synovial coverage was better in the hamstring tendon autograft group than that for the tibialis anterior allograft group. CONCLUSION: The hamstring autograft group had superior synovial coverage compared to that of the other group on second look arthroscopy. But there were no significant difference of the clinical outcomes between the groups.

¿Puede estimarse el diámetro del injerto cuádruple semitendinoso-gracilis en el preoperatorio, en relación al género y edad del paciente? / Can we predict the diameter of the hamstring autograft before ACL surgery based on the patient´s sex and age?

We studied the relation between quadruple hamstring autograft diameter with sex and age of the patients that underwent Anterior Cruciate Ligament (ACL) reconstructive surgery. Our purpose was to predict the diameter of the autograft before surgery and to describe the diameter distribution in our population. Methods: Between April 1998 and July 2005, 220 patients were operated for ACL tears using autologous quadruple STG grafts. We reviewed surgical protocols. Results: 70 percent of patients were males (average age: 25.2 years) and 30 percent females (average age: 27.5 years). The average autograft diameter was 8.4 mm: 8.6 mm for males and 8.05 mm for females exhibiting a significant difference (p < 0.0001). We did not find a significant correlation between graft diameter and patient´s age. Conclusion: The quadruple STG autograft diameter describes a Gaussian curve and is significantly greater in men than in women. Although we didn´t find correlation between age and diameter, a trend was present in the male´s group.

Determinar si en pacientes con indicación de reconstrucción de Ligamento Cruzado Anterior con autoinjerto cuádruple de Semitendinoso-Gracilis, se puede predecir el diámetro del injerto en base al sexo y la edad. Métodos: Entre Abril de 1998 y Julio de 2005 se operaron 220 pacientes de LCA con autoinjerto cuádruple de STG. Se analizaron protocolos operatorios. Resultados: 70 por ciento de los pacientes eran hombres edad promedio de 25,2 años y el 30 por ciento mujeres con edad promedio de 27,5 años. El promedio de los diámetros fue 8,4 mm, siendo 8,6 mm para hombres y 8,05 mm para mujeres, existiendo diferencia significativa (p < 0,0001). No hubo correlación entre diámetro del injerto y edad. Conclusión: El diámetro del injerto cuádruple STG describe una curva gaussiana, siendo mayor en hombres que en mujeres, sin correlación entre edad y diámetro, pero existiendo sí tendencia a mayor diámetro con mayor edad en el grupo de hombres.

Comparison of Arthroscopic Anterior Cruciate Ligament Reconstruction between Autologous Hamstring Tendonand Bone-patellar Tendon-bone Graft: Short Term FollowUp / 대한정형외과학회잡지

PURPOSE: To evaluate the stability, activity level and clinical results of an autologous hamstring and Bone-patellar tendon-bone (BPTB) graft in an Anterior cruciate ligament (ACL) reconstruction. MATERIALS AND METHODS: Between September 1997 and January 2003, 22 patients with an ACL reconstruction with an autologous four strand hamstring tendon, and 30 patients with a BPTB autograft were enrolled in this study. At the time of the final follow-up, the patients were evaluated by stress radiographs using a Telos instrument, the Lysholm score, Tegner activity score, IKDC activity grades, and anterior kneeling pain. RESULTS: An evaluation of the anterior laxity using the Telos instrument revealed no significant difference in the hamstring and BPTB groups: side to side difference 2.6 mm in the hamstring group vs 2.3 mm in the BPTB groups (p>0.05). The Lysholm score improved from a preoperative score of 58 to a postoperative score of 88 in the hamstring groups and from 56 to 91 in the BPTB groups. The Tegner score for the hamstring groups was 2.4 preoperatively and 5.8 at the final follow up, and the Tegner score for the BPTB groups were 2.3 and 6.2 preoperatively and after the last follow-up, respectively. The Tegner score was similar in the two treatment groups (p>0.05). According to the IKDC rating system, 9% were normal and 64% were almost normal in the hamstring group. In the BPTB group, 10% were normal and 67% were almost normal. Anterior kneeling pain after a reconstruction with the hamstring tendon autograft (13%) was significantly less common than with the patellar tendon autograft (37%)(p<0.05). CONCLUSION: The hamstring autograft for an ACL reconstruction decreased the incidence of anterior kneeling pain and produced equivalent clinical results to the BPTB autograft.

Comparison of the Suspensory and Double Cross-pin Graft Fixation after ACL Reconstruction Using Hamstring Autograft / 中国运动医学杂志

Objective To compare the clinical results of Endobutton and Rigidfix graft fixation at the femoral tunnel after ACL reconstruction with hamstring autografts.Methods 48 patients accepting ACL reconstruction with hamstring autografts were retrospective studied.According to different fixation adopted at the femoral tunnel,they were divided into group A(24 patients,with Rigidfix cross pin)and group B(24 patients,with Endobutton).All cases were fixed with Intrafix interference screw and Spiked Washer screw at the tibial tunnel.The average follow-up time was 27 months.KT-1000 arthrometric measurement and the IKDC,Lysholm,Tegner scores were used for evaluation.The diameter of bone tunnel was also measured by MRI.Results Tunnel widening were found in both groups,but the increase of both the femoral and tibial tunnels in group B were significantly greater than group(P