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No Difference in Functional Outcomes and Stability but Lesser Tunnel Widening With Tibial Suspensory Fixation
Nayeem Z Hali1, Hersh Punjani1, Muaaz Tahir2
1Worcestershire Acute Hospitals NHS Trust, Worcester, UK.
Purpose:
To compare tibial suspensory fixation (TSF) with tibial interference screw (TIS) in anterior cruciate ligament (ACL) reconstruction for clinical and radiological outcomes.
Methods:
A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using MEDLINE, PubMed, and Embase databases. The review was registered with the PROSPERO database. Clinical comparative studies of ACL reconstruction with hamstring autograft with TSF and TIS were included. Primary outcome measures include functional outcome in terms of International Knee Documentation Committee, Lysholm and Tegner scores, knee laxity, and radiologic outcomes in terms of tunnel widening. Secondary outcome measures include isokinetic muscle strength and complications like graft failure. Studies were appraised using Cochrane risk of bias tool for randomized controlled trials and Methodological Index for Non-Randomized Studies score.
Results:
Seventeen clinical comparative studies (TSF, n = 4262; TIS, n = 3085) met eligibility criteria. Of these, 72.9% (TSF) and 75.7% (TIS) of patients were males. Follow-up ranged from 24 to 40 months for clinical outcomes and 6 to 24 months for radiological outcomes. Included studies report no difference in knee functional scores (International Knee Documentation Committee [mean difference, range -3.40 to 5.10], Tegner [mean difference, range -1.20 to 0.60], and Lysholm score [mean difference, range -4.00 to 1.30]) between the TSF and TIS groups. The studies also report no difference in knee laxity (KT-1000 [mean difference, range -0.40 to 1.50]). Two studies revealed superior knee flexor strength at 2 years with TSF compared with TIS (Goyal et al., 25.8 ± 4.2 vs 23.5 ± 2.5 lbs, P = .002). No major complications were reported in most of the studies except 1 which showed a higher revision rate with TIS (TSF 3.4% vs TIS 5.4%, P < .001). Radiologically, the studies show greater tibial tunnel widening with TIS compared with TSF (mean difference, range -2.40 to -1.61).
Conclusions:
TSF in hamstring autograft ACL reconstruction shows similar functional outcomes and knee stability when compared with interference screw at a minimum clinical follow-up of 24 months. The present systematic review also highlights superior knee flexor strength with TSF with no major difference in the complications including graft failure rate. The use of TSF using hamstring autograft is a reliable option for ACL reconstruction.
Level Of Evidence:
Level IV, systematic review of Level I to IV studies.