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[Biodegradable screw versus a press-fit bone plug fixation for ACL reconstruction: a prospective randomized study].
B Geiges1, C von Falck, K Knobloch
1Abteilung Orthopädie/Unfallchirurgie/Sportmedizin, Agnes-Karll-Krankenhaus, Laatzen, Hildesheimer Straße 158, 30880, Laatzen, Deutschland. Bjoern.Geiges@krh.eu
Der Unfallchirurg
|September 3, 2011
Summary
Press-fit fixation for anterior cruciate ligament (ACL) reconstruction using a porous bone scaffold significantly reduces tibial tunnel enlargement compared to interference screws. This method shows promise for improved tendon-to-bone healing and knee stability.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Sports Medicine
Background:
- Press-fit fixation is a technique used in tendon graft fixation to promote tendon-to-bone healing.
- Bone tunnel enlargement after anterior cruciate ligament (ACL) reconstruction can compromise graft stability and long-term outcomes.
Purpose of the Study:
- To compare the efficacy of press-fit fixation with a porous bone scaffold versus biodegradable interference screw fixation in limiting bone tunnel enlargement after ACL reconstruction.
- To evaluate the impact of fixation methods on clinical outcomes and knee stability.
Main Methods:
- A randomized study involving 20 patients undergoing primary ACL reconstruction.
- Patients were assigned to either interference screw (I) or press-fit porous bone cylinder (P) fixation in the tibial tunnel.
- Computed tomography (CT) scans were used to measure bone tunnel enlargement at three months post-surgery; clinical scores (IKDC, Tegner, Lysholm) were assessed at six months, one year, and two years.
Main Results:
- Press-fit fixation (Group P) demonstrated significantly less bone tunnel enlargement in both the anteroposterior (106.9±10.9% vs 121.9±9.0%, P<0.02) and coronal (102.8±15.2% vs 121.5±10.1%, P<0.01) planes compared to interference screws (Group I).
- Both groups showed significant improvements in IKDC, Tegner, and Lysholm scores post-surgery, with no statistically significant differences between the fixation methods.
- A trend towards improved knee stability was observed in the press-fit group at three months (0.6±1.4 mm vs 1.81±.5 mm, P=0.08).
Conclusions:
- Both interference screw and press-fit fixation techniques yield favorable outcomes in ACL reconstruction.
- Tibial press-fit fixation with a porous bone scaffold effectively reduces proximal bone tunnel enlargement.
- Press-fit fixation may enhance bone-to-tendon contact, potentially improving graft integration.