Clinical and radiological results of two different arthroscopic techniques using quadrupled hamstring tendon grafts in ACL-reconstruction

ABSTRACT

Purpose: The purpose of the study was to evaluate the clinical and radiological outcome of two different methods of primary anterior cruciate ligament [ACL] reconstruction using quadrupled hamstring tendons with a minimum follow-up of two years. Type of study Retrospective study. 45 patients were evaluated 2 years after endoscopic ACL-reconstruction. Two methods of graft fixation were compared In group 1 [20 patients, EB-group] an indirect graft fixation was achieved utilizing the Endobutton [Acufex, Mansfield, MA] with manually knotted polyester tape for proximal femoral fixation combined with bicortical suture and post tibial fixation. In group 2 [25 patients, TF-group] a direct graft fixation was achieved utilizing cross pin femoral fixation [Arthrex Trans Fix II Pin, Naples, FL.] with an additional autograft bone plug inserted into the femoral tunnel. Tibial fixation of the graft was performed with a bioabsorbable interference screw and an additional staple on the graft. All cases were operated using a transtibial technique. According to the IKDC-evaluation patients of the TF group performed clinically better compared to the EB-group. Radio- graphs of the EB-group demonstrated a higher degree of divergence of the osteoscierotic lines indicating the bone tunnels in comparison to the TF-group. The entrance diameter of the drilled femoral bone tunnels were 12.5 mm and 10.5 mm in the EB-group and TF-group, respectively [p0.05]. Avoiding tapes and sutures and using a surgical technique with direct graft fixation minimizes movement of the tendon graft for ACL-reconstruction and improves clinical results: