Journal List > J Korean Orthop Assoc > v.42(3) > 1012667

Cho, Gwak, and Jung: Anterior Cruciate Ligament Reconsruction using Tibialis Tendon Allograft - Comparison of the Results according to the Femoral Fixation Methods -

Abstract

Purpose

To compare the clinical stability and function of two femoral fixation methods after arthroscopic anterior cruciate ligament (ACL) reconstruction using fresh-frozen tibialis tendon allograft.

Materials and Methods

For femoral fixation, endopearl and bioabsorbable interference screw were used in 31 patients (group I) and RIGIDfix®, in 36 patients (group II). The mean follow-up period was 30 months. The evaluations included Lysholm knee score, 2000 International Knee Documentation Committee (IKDC) subjective knee score, Lachman test, pivot shift test, KT-1000 arthrometer measurement and 2000 IKDC knee examination.

Results

Twenty-eight patients (90.3%) in group I and 33 (91.7%) in group II were good or excellent according to the Lysholm score. Twenty-seven patients (87.1%) in group I and 33 (91.7%) in group II had IKDC subjective knee score >70. Thirty patients (96.8%) in group I and 35 (97.2)% in group II had 1+firm end or negative Lachman test. Twenty-seven patients (87.1%) in group I and 35 (97.2%) in group II had a negative pivot shift. Thirty patients (96.8%) in group I and 36 (100%) in group II had <5 mm of difference according to the KT-1000 arthrometer. Twenty-nine patients (93.5%) in group I and 34 (94.4%) in group II were normal or nearly normal according to the 2000 IKDC knee examination.

Conclusion

ACL reconstruction with fresh-frozen tibialis tendon allograft produced a reliable and predictable outcome after the short-term follow-up. The two methods used for femoral fixation produced similar outcomes.

Figures and Tables

Fig. 1
Endopearl was sutured to the proximal end of the double-stranded tibialis tendon allograft (A). A whipstitch was done except for the intra-articular portion of the graft (A, B).
jkoa-42-373-g001
Fig. 2
The tibial drill guide was set to 30-40° in horizontal plane (A) and at 40-45° in the sagittal plane (B). The starting point for the guide pin on the proximal tibia was proximal to the pes anserinus and anterior to the medial collateral ligament. TT, tibial tuberosity.
jkoa-42-373-g002
Fig. 3
The intraarticular guide tip was located approximately 1 mm anterior and medial to the conventional site, which was the inner margin of the lateral meniscus anterior horn and just the lateral side of the medial tibial spine. LM, lateral meniscus; ACL, anterior cruciate ligament.
jkoa-42-373-g003
Table 1
Results of the Lysholm Score and 2000 IKDC Subjective Knee Score
jkoa-42-373-i001
Table 2
Results of the Objective Tests
jkoa-42-373-i002
Table 3
Results of the 2000 IKDC Knee Examination
jkoa-42-373-i003

References

1. Arneja S, Froese W, MacDonald P. Augmentation of femoral fixation in hamstring anterior cruciate ligament reconstruction with a bioabsorbable bead. Am J Sports Med. 2004. 32:159–163.
crossref
2. Chang SK, Egami DK, Shaieb MD, Kan DM, Richardson AB. Anterior cruciate ligament reconstruction: allograft versus autograft. Arthroscopy. 2003. 19:453–462.
crossref
3. Harding N, Barber FA, Herbert MA. The effect of the EndoPearl on soft-tissue graft fixation. J Knee Surg. 2002. 15:150–154.
4. Kanamori A, Woo SL, Ma CB, et al. The forces in the anterior cruciate ligament and knee kinematics during a simulated pivot shift test: a human cadaveric study using robotic technology. Arthroscopy. 2000. 16:633–639.
crossref
5. Lee DC. Graft selection in ACL reconstruction. J Korean Orthop Soc Sports Med. 2003. 2:92–99.
6. Mahirogullari M, Oguz Y, Ozkan H. Reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone graft with double biodegradable femoral in fixation. Knee Surg Sports Traumatol Arthrosc. 2006. 14:646–653.
7. Miller SL, Gladstone JN. Graft selection in anterior cruciate ligament reconstruction. Orthop Clin North Am. 2002. 33:675–683.
crossref
8. Nyland J, Caborn DN, Rothbauer J, Kocabey Y, Couch J. Two-year outcomes following ACL reconstruction with allograft tibialis anterior tendons: a retrospective study. Knee Surg Sports Traumatol Arthrosc. 2003. 11:212–218.
crossref
9. Pearsall AW 4th, Hollis JM, Russell GV Jr, Scheer Z. A biomechanical comparison of three lower extremity tendons for ligamentous reconstruction about the knee. Arthroscopy. 2003. 19:1091–1096.
crossref
10. Rose T, Hepp P, Venus J, Stockmar C, Josten C, Lill H. Prospective randomized clinical comparison of femoral transfixation versus bioscrew fixation in hamstring tendon ACL reconstruction--a preliminary report. Knee Surg Sports Traumatol Arthrosc. 2006. 14:730–738.
crossref
11. Shino K, Kimura T, Hirose H, Inoue M, Ono K. Reconstruction of the anterior cruciate ligament by allogeneic tendon graft. An operation for chronic ligamentous insufficiency. J Bone Joint Surg Br. 1986. 68:739–746.
crossref
12. Stringham DR, Pelmas CJ, Burks RT, Newman AP, Marcus RL. Comparison of anterior cruciate ligament reconstructions using patellar tendon autograft or allograft. Arthroscopy. 1996. 12:414–421.
crossref
13. Woo SL, Kanamori A, Zeminski J, Yagi M, Papageorgiou C, Fu FH. The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am. 2002. 84:907–914.
14. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL. Biomechanical analysis of anatomic anterior cruciate ligament reconstruction. Am J Sports Med. 2002. 30:660–666.
15. Yunes M, Richmond JC, Engels EA, Pinczewski LA. Patellar versus hamstring tendons in anterior cruciate ligament reconstruction: a meta-analysis. Arthroscopy. 2001. 17:248–257.
TOOLS
Similar articles