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Published on: March 1, 2024
Effect of Soft Tissue Interposition and Postoperative Suspensory Cortical Button Migration on Functional Outcomes and
Emre Anıl Özbek1, Hakan Kocaoğlu1, Mustafa Onur Karaca1
1Orthopedics and Traumatology Department, Ankara University, Ankara, Turkey.
Background:
Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR).
Purpose:
To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity.
Results:
There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (<3 mm) was detected in 83.7% of the patients postoperatively, and all patients showed statistically significant pre- to postoperative improvement on the Tegner (from 4.1 to 4.3) and Lysholm (from 44.0 to 89.2) scores (P < .05 for both). No significant difference in postoperative functional results or graft ligamentization was found between either the soft tissue interposition groups (groups 1 and 2) or the suspensory cortical button migration groups (groups M and non-M).
Conclusion:
Differences between patients in soft tissue interposition and suspensory cortical button migration did not significantly affect postoperative clinical or functional outcomes or graft ligamentization after single-bundle ACLR.
