Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up

Wojciech Widuchowski, Malgorzata Widuchowska, Bogdan Koczy, Szymon Dragan, Andrzej Czamara, Wieslaw Tomaszewski, Jerzy Widuchowski, Wojciech Widuchowski, Malgorzata Widuchowska, Bogdan Koczy, Szymon Dragan, Andrzej Czamara, Wieslaw Tomaszewski, Jerzy Widuchowski

Abstract

Background: If anterior cruciate ligament (ACL) reconstruction is to be performed, decision regarding graft choice and its fixation remains one of the most controversial. Multiple techniques for ACL reconstruction are available. To avoid disadvantages related to fixation devices, a hardware-free, press-fit ACL reconstruction technique was developed. The aim of this study was to evaluate clinical outcome and osteoarthritis progression in long term after ACL reconstruction with central third patellar-tendon autograft fixed to femur by press-fit technique.

Methods: Fifty two patients met inclusion/excusion criteria for this study. The patients were assessed preoperatively and at 15 years after surgery with International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, Tegner activity scale and radiographs.

Results: Good overall clinical outcomes and self-reported assessments were documented, and remained good at 15 years. The mean Lysholm and Tegner scores improved from 59.7 ± 18.5 and 4.2 ± 1.0 preoperatively to 86.4 ± 5.6 (p = 0.004) and 6.9 ± 1.4 (p = 0.005) respectively at follow-up. The IKDC subjective score improved from 60.1 ± 9.2 to 80.2 ± 8.1 (p = 0.003). According to IKDC objective score, 75% of patients had normal or nearly normal knee joints at follow-up. Grade 0 or 1 results were seen in 85% of patients on laxity testing. Degenerative changes were found in 67% of patients. There was no correlation between arthritic changes and stability of knee and subjective evaluation (p > 0.05).

Conclusions: ACL reconstruction with patellar tendon autograft fixed to femur with press-fit technique allows to achieve good self-reported assessments and clinical ligament evaluation up to 15 years. Advantages of the bone-patellar-tendon-bone (BPTB) press-fit fixation include unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery. BPTB femoral press-fit fixation technique can be safely applied in clinical practice and enables patients to return to preinjury activities including high-risk sports.

Figures

Figure 1
Figure 1
The bone blocks aree formed to a trapezoid shape by using an oscillating saw. The tibial bone block must be sized so that its basis can pass through tunnel of 10-11 mm diameter and rest of the bone block 9–10 mm diameter.
Figure 2
Figure 2
The tibial bone plug is tapped into the femoral tunnel and fixed with press-fit. The patellar bone plug is secured in the tibial tunnel with an interference screw.

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Source: PubMed

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