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. 2019 Nov;27(11):3518-3526.
doi: 10.1007/s00167-019-05431-4. Epub 2019 Mar 1.

Femoral-tibial fixation affects risk of revision and reoperation after anterior cruciate ligament reconstruction using hamstring autograft

Lindsey M Spragg  1 , Heather A Prentice  2 , Andrew Morris  3 , Tadashi T Funahashi  1 , Gregory B Maletis  4 , Rick P Csintalan  5
Affiliations

Femoral-tibial fixation affects risk of revision and reoperation after anterior cruciate ligament reconstruction using hamstring autograft

Lindsey M Spragg et al. Knee Surg Sports Traumatol Arthrosc. 2019 Nov.

Abstract

Purpose: Newer fixation devices for hamstring (HS) autograft have been introduced over the years, yet the impact of these devices on ACLR outcomes requiring surgical intervention remains unclear. We sought to evaluate the risk of aseptic revision and reoperation after HS autograft ACLR according to various femoral-tibial fixation methods.

Methods: A cohort study was conducted using the Kaiser Permanente ACLR Registry. Primary isolated unilateral ACLR patients who received a HS autograft were identified (2007-2014). Fixation devices were categorized as crosspin, interference, suspensory, or combination (defined as more than one fixation device used on the same side) and femoral-tibial fixation groups used in more than 500 ACLR were evaluated. Cox proportional-hazard regression was used to evaluate the association between femoral-tibial fixation method and outcomes while adjusting for confounders.

Results: 6,593 primary ACLR were included. Four femoral-tibial fixation groups had more than 500 ACLR: suspensory-interference (n = 3004, 45.6%), interference-interference (n = 1659, 25.2%), suspensory-combination (n = 1103, 16.7%), and crosspin-interference (n = 827, 12.5%). After adjusting for covariates, revision risk was lower for crosspin-interference (HR = 0.43, 95% CI 0.29-0.65) and interference-interference (HR = 0.63, 95% CI 0.41-0.95) methods compared to the suspensory-interference. In contrast, reoperation risk was higher for crosspin-interference (HR = 2.13, 95% CI 1.37-3.32) and suspensory-combination (HR = 1.68, 95% CI 1.04-2.69) methods compared to suspensory-interference.

Conclusions: ACLR using HS autograft appears to have the lowest risk of aseptic revision when crosspin or interference fixation is used on the femoral side and is coupled with an interference screw on the tibial side.

Level of evidence: III.

Keywords: ACL reconstruction; Femoral fixation; Hamstring autograft; Reoperation; Revision; Tibial fixation.

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References

    1. Am J Sports Med. 2015 Sep;43(9):2182-8 - PubMed
    1. Arch Orthop Trauma Surg. 2013 Sep;133(9):1197-202 - PubMed
    1. Am J Sports Med. 2014 Oct;42(10):2319-28 - PubMed
    1. Orthop Clin North Am. 2010 Apr;41(2):249-62 - PubMed
    1. Knee Surg Sports Traumatol Arthrosc. 2013 May;21(5):1111-8 - PubMed