Background: Hamstring graft tendon for anterior cruciate ligament (ACL) reconstruction is a common approach worldwide. Tibial side graft fixation to achieve appropriate stability is a serious concern, worldwide. The current study aims to compare the outcomes of mere use of interference screw for fixation of hamstring tendon graft versus the use of interference screw plus supplementary staple. Materials and Methods: This is a randomized clinical trial conducted on 53 patients who underwent ACL reconstruction from 2016 to 2018. The study population was randomly divided into two groups: graft fixation with interference screw only and interference screw plus supplementary staple. Postoperative recovery time, postoperative clinical examinations, and the scale of the International Knee Documentation Committee were assessed for participants and compared between two groups. Results: Comparison of two groups regarding demographic information, including age, gender distribution, postoperative recovery time, and body mass index, showed no statistical difference (P > 0.05). Postoperative Pivot test was insignificantly positive in 4 (16.7%) cases of screw interference with supplementary staple while it was positive in 3 (10.7%) cases with screw interference only approach (P = 0.98). IKCD index was not statistically different between two groups postoperatively (P = 0.72), while IKCD scores changed significantly following the surgical procedure, regardless of the type of the surgical procedure (P < 0.001). Conclusion: Use of supplementary staple beside interference screw was as successful as mere use of interference screw for fixation of hamstring tendon autologous graft of the ACL reconstruction, regarding force withstanding. The comparison of the two approaches revealed no remarkable difference.
Poolman RW, Farrokhyar F, Bhandari M. Cumulative meta-analysis and clinically relevant sensitivity analysis show evidence for hamstring tendon autograft superiority compared to bone patellar-tendon bone autograft in ACL reconstruction. Moving towards Evidence-Based Orthopaedic Surgery.2007;12:256-262.
Laxdal G, Kartus J, Eriksson BI, Faxén E, Sernert N, Karlsson J. Biodegradable and metallic interference screws in anterior cruciate ligament reconstruction surgery using hamstring tendon grafts: Prospective randomized study of radiographic results and clinical outcome. Am J Sports Med 2006;34:1574-80.
Ghodadra NS, Mall NA, Grumet R, Sherman SL, Kirk S, Provencher MT, et al. Interval arthrometric comparison of anterior cruciate ligament reconstruction using bone–patellar tendon–bone autograft versus allograft: Do grafts attenuate within the first year postoperatively? Am J Sports Med 2012;40:1347-54.