Anterior cruciate ligament reconstruction: a new cortical suspension device for femoral fixation with transtibial and transportal techniques

Journal of Orthopaedic Surgery and Research

Patrícia Maria de Moraes Barros Fucs¹  Nilson Roberto Severino¹  Osmar Pedro Arbix de Camargo¹  Victor Marques de Oliveira¹  Ricardo de Paula Leite Cury¹  Luiz Gabriel Betoni Guglielmetti¹ 

[1] Department of Orthopedics and Traumatology, Santa Casa Medical School and Hospitals, R. Dr. Cesário Motta Junior, 112, São Paulo 01221-020, Brazil

关键词: Knee;    Arthroscopy;    Orthopedic fixation devices;    Anterior cruciate ligament;   

Others  :  1144398
DOI  :  10.1186/s13018-014-0110-7

 received in 2014-04-24, accepted in 2014-10-27,  发布年份 2014

【 摘 要 】

Background

In the field of anterior cruciate ligament (ACL) reconstruction, there is still no consensus regarding the proper fixation method and position of the tunnels. The primary objective of this paper was to describe a new fixation device, the Endo Tunnel Device (ETD®), for both techniques (transtibial and transportal), as well as the associated difficulties and the intraoperative and postoperative intercurrences. The secondary objective was to describe a preliminary clinical evaluation (6 months of follow-up) comparing these techniques.

Methods

This was a prospective, randomized study involving 80 patients with ACL reconstructions using the ETD® for femoral fixation. Forty patients underwent the transtibial technique, and 40 patients underwent the transportal technique. Patients were evaluated by radiography, physical examination, the KT1000 arthrometer, and Lysholm and the International Knee Documentation Committee (IKDC) scores.

Results

There were more intraoperative intercurrences in the transportal group (soft tissue device fixation, short femoral tunnel, and short graft inside the tunnel). The IKDC scores were significantly better in the transportal group.

Conclusions

The ETD® was demonstrated to be a safe femoral fixation device in this trial; its use in both the transtibial and transportal techniques is technically simple and is associated with few intra- or postoperative complications.

【 授权许可】

   
2014 Guglielmetti et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Emond CE, Woelber EB, Kurd SK, Ciccotti MG, Cohen SB: A comparison of the results of anterior cruciate ligament reconstruction using bioabsorbable versus metal interference screws: a meta-analysis. J Bone Joint Surg Am 2011, 93(6):572-580.
• [2]Milano G, Mulas PD, Ziranu F, Piras S, Manunta A, Fabbriciani C: Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: a biomechanical analysis. Arthroscopy 2006, 22(6):660-668.
• [3]Shen HC, Chang JH, Lee CH, Shen PH, Yeh TT, Wu CC, Kuo CL: Biomechanical comparison of Cross-pin and Endobutton-CL femoral fixation of a flexor tendon graft for anterior cruciate ligament reconstruction¿a porcine femur-graft-tibia complex study. J Surg Res 2010, 161(12):282-287.
• [4]Oh YH, Namkoong S, Strauss EJ, Ishak C, Hecker AT, Jazrawi LM, Rosen J: Hybrid femoral fixation of soft-tissue grafts in anterior cruciate ligament reconstruction using the EndoButton CL and bioabsorbable interference screws: a biomechanical study. Arthroscopy 2006, 22(11):1218-1224.
• [5]Han DL, Nyland J, Kendzior M, Nawab A, Caborn DN: Intratunnel versus extratunnel fixation of hamstring autograft for anterior cruciate ligament reconstruction. Arthroscopy 2012, 28(10):1555-1566.
• [6]Stengel D, Casper D, Bauwens K, Ekkernkamp A, Wich M: Bioabsorbable pins and interference screws for fixation of hamstring tendon grafts in anterior cruciate ligament reconstruction surgery: a randomized controlled trial. Am J Sports Med 2009, 37(9):1692-1698.
• [7]Ma CB, Francis K, Towers J, Irrgang J, Fu FH, Harner CH: Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation. Arthroscopy 2004, 20(2):122-128.
• [8]Steiner M: Anatomic single-bundle ACL reconstruction. Sports Med Arthrosc 2009, 17(4):247-251.
• [9]Heming JF, Rand J, Steiner ME: Anatomic limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 2007, 35(10):1708-1715.
• [10]Steiner ME, Battaglia TC, Heming JF, Rang JD, Festa A, Baria M: Independent drilling outperforms conventional transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 2009, 37(10):1912-1919.
• [11]Sim JA, Gadikota HR, Li JS, Li G, Gill TJ: Biomechanical evaluation of knee joint laxities and graft forces after anterior cruciate ligament reconstruction by anteromedial portal, outside-in, and transtibial techniques. Am J Sports Med 2011, 39(12):2604-2610.
• [12]Bedi A, Musahl V, Steuber V, Kendoff D, Choi D, Allen AA, Pearle AD, Altchek DW: Transtibial versus anteromedial portal reaming in anterior cruciate ligament reconstruction: an anatomic and biomechanical evaluation of surgical technique. Arthroscopy 2011, 27(3):380-390.
• [13]Alentorn-Geli E, Samitier G, Alvarez P, Steinbacher G, Cugat R: Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up. Int Orthop 2010, 34(5):747-754.
• [14]Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH: Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 2012, 40(3):512-520.
• [15]Anderson AF, Irrgang JJ, Kocher MS, Mann BJ, Harrast JJ: The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med 2006, 34(1):128-135.
• [16]Lysholm J, Gillquist J: Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982, 10:150-154.
• [17]Mae T, Kuroda S, Matsumoto N, Yoneda M, Nakata K, Yoshikawa H, Shino K: Migration of EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2011, 27(11):1528-1535.
• [18]Lubowitz JH: Anteromedial portal technique for the anterior cruciate ligament femoral socket: pitfalls and solutions. Arthroscopy 2009, 25(1):95-101.
• [19]Nakamura M, Deie M, Shibuya H, Nakamae A, Adachi N, Aoyama H, Ochi M: Potential risks of femoral tunnel drilling through the far anteromedial portal: a cadaveric study. Arthroscopy 2009, 25(5):481-487.
• [20]Gavriilidis I, Motsis EK, Pakos EE, Georgoulis AD, Mitsionis G, Xenakis TA: Transtibial versus anteromedial portal of the femoral tunnel in ACL reconstruction: a cadaveric study. Knee 2008, 15(5):364-367.