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. 2018 Oct 12;19(1):368.
doi: 10.1186/s12891-018-2271-8.

Long-term follow-up after anterior cruciate ligament reconstruction using a press-fit quadriceps tendon-patellar bone autograft

Alexander Barié  1 , Michael Köpf  2 , Ayham Jaber  2 , Babak Moradi  2 , Holger Schmitt  3 , Jürgen Huber  4 , Nikolaus Alexander Streich  4
Affiliations

Long-term follow-up after anterior cruciate ligament reconstruction using a press-fit quadriceps tendon-patellar bone autograft

Alexander Barié et al. BMC Musculoskelet Disord. .

Abstract

Background: The use of a quadriceps tendon-patellar bone (QTPB) autograft provides an alternative procedure in primary reconstruction of the anterior cruciate ligament (ACL). Using the press-fit technique for femoral fixation and knotting over a bone bridge as well as additional spongiosa filling for tibial fixation can completely eliminate the need for fixation implants. The objective of this study was to evaluate the long-term clinical, functional and radiological results of this operating method.

Methods: Sixty-nine patients (27 female-42 male) were included in this study. Fifty-seven patients (83%) received a comprehensive follow-up review after an average period of 7.5 years (range: 7-8.7). All other patients were surveyed by telephone. Six patients (9%) suffered a re-rupture of the ACL graft caused by a new related trauma and were therefore excluded from the statistical analysis.

Results: Of all patients, 98% were satisfied with the operation. Normal or almost normal results were recorded in the subjective IKDC scores form by 88% of the patients. The Lysholm score demonstrated very good and good results in 83% of the patients. Only 1 patient reported minor complaints in the donor area. Seven (12%) patients developed Cyclops syndrome with limited knee extension. This complication was treated arthroscopically within the first year postoperatively. Their results on follow-up were not worse than the results of the patients without Cyclops syndrome. Regarding the 57 patients who received a comprehensive evaluation, the stability test with the KT-1000 Arthrometer yielded a difference of less than 3 mm in the contralateral comparison for 89% of the operated knees. The pivot-shift test was normal in 79% and almost normal in 21%. In the Single-leg Triple Hop Test, patients achieved an average of 98% of the hopping distance attained with the contralateral leg. The radiological examination revealed a slight deterioration in the Kellgren-Lawrence Score in 2 patients.

Conclusion: The ACL reconstruction using the QTPB autograft performed with the press-fit technique leads to good results in comparison with published results of established procedures for primary ACL surgery using other autografts. Further investigations should involve comparative studies with the objective of providing evidence-based, individually adapted therapy for ACL rupture.

Keywords: Anterior cruciate ligament; Knee; Press-fit technique; Quadriceps tendon; Reconstruction.

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Conflict of interest statement

Ethics approval and consent to participate

This study has been approved by the appropriate ethics committee (Ethikkommission der Medizinischen Fakultät Heidelberg, Alte Glockengießerei 11/1, 69,115 Heidelberg: ethics votum Nr. S-091/2009) and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All persons gave their informed consent prior to their inclusion in the study.

Consent for publication

Not Applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
A 5 cm long, 1 cm wide and 6 to 8 mm-thick strip of the quadriceps tendon is dissected out and reinforced with Mersilene threads
Fig. 2
Fig. 2
The armed transplant before implantation
Fig. 3
Fig. 3
Diagram showing the press-fit fixation of the patellar bone cylinder in the femoral tunnel
Fig. 4
Fig. 4
Spongiosa transplantation filling up the tibial tunnel
See this image and copyright information in PMC

References

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