Abstract
Background
The decision regarding graft choice and fixation in anterior cruciate ligament (ACL)
reconstruction remains controversial. Free cylindrical bone plugs have been used successfully
as graft fixation method. However, some concerns continue to exist regarding how well
these plugs integrate with the bony walls of the tunnel. The aim of this study was
to assess osteo-integration of free cylindrical bone plugs and to evaluate its effect
on the clinical outcomes of the procedure.
Methods
From January 2015 to December 2017, 30 patients (21–40 years old) with torn ACL were
operated on and followed up for 24 months after surgery. All patients were assessed
clinically (International Knee Documentation Committee score (IKDC) and Tegner–Lysholm
knee scoring system), instrumentally (KT 1000 and Rolimeter), and radiologically (X-ray,
computed tomography and magnetic resonance imaging). Young active patients with torn
ACL were included while those with previous ligamentous injury and/or surgery were
excluded.
Results
All bone grafts showed solid bone healing after 6 months of surgery; incorporation
was ‘good to excellent’ (tibial side: 66.6%; femoral side: 86.6%). There was no correlation
between age or time interval and graft incorporation. Positive correlation was shown
between tibial and femoral graft incorporation within the same patient. Only one patient
was abnormal in our final objective IKDC scores (graded C). The mean side-to-side
difference with KT 1000 and Rolimeter was 1.9 and 1.8, respectively.
Conclusion
Free cylindrical bone plugs could be used safely for hamstring tendon graft fixation;
it enhances graft tunnel integration within the first 6 months and yields comparable
clinical outcomes whilst avoiding the potential hazards of foreign hardware implants.
Keywords
Abbreviations:
ACL (Anterior Cruciate Ligament)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The KneeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Biomechanical considerations in the pathogenesis of osteoarthritis of the knee.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 423-435
- Scaffolds for tendon and ligament repair: review of the efficacy of commercial products.Expert Rev Med Devices. 2009; 6: 61-73
- A prospective randomised study of ACL-reconstructions using bone-patellar tendon-bone grafts fixed with bioabsorbable or metal interference screws.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 753-759
- Similar biomechanical properties of four tripled tendon graft models for ACL reconstruction.Arch Orthop Trauma Surg. 2022; 142: 1155-1165https://doi.org/10.1007/s00402-021-04030-8
- ACL reconstruction using bone–patellar tendon–bone press-fit fixation: 10-year clinical results.Knee Surg Sports Traumatol Arthrosc. 2005; 13: 248-255
- Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon–graft with press-fit fixation without hardware. A new and innovative procedure.Orthop Clin North Am. 2003; 34: 49-64
- Biodegradable screw versus a press-fit bone plug fixation for hamstring anterior cruciate ligament reconstruction: A prospective randomised study.Am J Sports Med. 2010; 38: 501-508
- Implant free press fit fixation hamstring ACl reconstruction.Arch Orthop Trauma Surg. 2010; 130: 985-992
- Clinical outcome after implant-free ACL reconstruction with hamstring tendon graft.Eur Orthop Traumatol. 2015; 6: 363-371
- Bone tunnel widening after anterior cruciate ligament reconstruction using EndoButton or EndoButton continuous loop.Arthroscopy. 2009; 25: 1275-1280
- Early integration of a bone plug in the femoral tunnel in rectangular tunnel ACL reconstruction with a bone-patellar tendon-bone graft: A prospective computed tomography analysis.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 29-35
Bjornara BT, Aune AK. T evaluation of patellar tendon-bone graft healing after anterior cruciate ligament reconstruction. P-0001-ESSR-Scientific Exhibit; 2013. https://doi.org/10.1594/essr2013/P-0001.
- Press-fit femoral fixation in ACL reconstruction using bone-patellar tendon- bone graft.Acta Medica Iranica. 2009; 47: 143-148
- Press-fit fixation using autologous bone in the tibial canal causes less enlargement of bone tunnel diameter in ACL reconstruction – a CT scan analysis three months.BMC Musculoskelet Disord. 2015; 16: 200https://doi.org/10.1186/s12891-015-0656-5
- Bone plug length and loading angle determine the primary stability of patellar tendon-bone grafts in press-fit ACL reconstruction.Knee Surg Sports Traumatol Arthrosc. 2006; 14: 108-111https://doi.org/10.1007/s00167-005-0645-6 108-111
Article info
Publication history
Published online: June 29, 2022
Accepted:
May 31,
2022
Received in revised form:
May 7,
2022
Received:
April 22,
2021
Identification
Copyright
© 2022 Published by Elsevier B.V.
