Investigation of Hamstring Tendon Graft Fixation for the Reconstruction of Anterior Cruciate Ligament using Interference Screw Merely or in Combination with Supplementary Staple: A Clinical Trial

Mousavi, Sayed Hamid; Masoumi, Omid; Akbariaghdam, Hossein; Mohammadsharifi, Ghasem

Investigation of Hamstring Tendon Graft Fixation for the Reconstruction of Anterior Cruciate Ligament using Interference Screw Merely or in Combination with Supplementary Staple: A Clinical Trial

Document Type : Original Article

Authors

¹ Department of Orthopedics, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Orthopedics, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

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.

Keywords

References

1.	Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: A controlled, prospective trial. Am J Sports Med 2007;35:564-74.
2.	De Wall M, Scholes CJ, Patel S, Coolican MR, Parker DA. Tibial fixation in anterior cruciate ligament reconstruction: A prospective randomized study comparing metal interference screw and staples with a centrally placed polyethylene screw and sheath. Am J Sports Med 2011;39:1858-64.
3.	Goldblatt JP, Fitzsimmons SE, Balk E, Richmond JC. Reconstruction of the anterior cruciate ligament: Meta-analysis of patellar tendon versus hamstring tendon autograft. Arthroscopy 2005;21:791-803.
4.	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.
5.	Wagner M, Kääb MJ, Schallock J, Haas NP, Weiler A. Hamstring tendon versus patellar tendon anterior cruciate ligament reconstruction using biodegradable interference fit fixation: A prospective matched-group analysis. Am J Sports Med 2005;33:1327-36.
6.	Li S, Chen Y, Lin Z, Cui W, Zhao J, Su W. A systematic review of randomized controlled clinical trials comparing hamstring autografts versus bone-patellar tendon-bone autografts for the reconstruction of the anterior cruciate ligament. Arch Orthop Trauma Surg 2012;132:1287-97.
7.	Duncan RM, Meuffels E, Docter PT, van Dongen RA, Kleinrensink GJ, Jan AN, et al. Novel insights into anterior cruciate ligament injury. Erasmus University Rotterdam 2010;26:65.
8.	Scranton PE Jr., Bagenstose JE, Lantz BA, Friedman MJ, Khalfayan EE, Auld MK. Quadruple hamstring anterior cruciate ligament reconstruction: A multicenter study. Arthroscopy 2002;18:715-24.
9.	Bartz RL, Mossoni K, Tyber J, Tokish J, Gall K, Siparsky PN. A biomechanical comparison of initial fixation strength of 3 different methods of anterior cruciate ligament soft tissue graft tibial fixation: Resistance to monotonic and cyclic loading. Am J Sports Med 2007;35:949-54.
10.	Kousa P, Järvinen TL, Vihavainen M, Kannus P, Järvinen M. The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part I: Femoral site. Am J Sports Med 2003;31:174-81.
11.	Brand J Jr., Weiler A, Caborn DN, Brown CH Jr., Johnson DL. Graft fixation in cruciate ligament reconstruction. Am J Sports Med 2000;28:761-74.
12.	Gwynne-Jones DP, Draffin J, Vane AG, Craig RA, McMahon SF. Failure strengths of concentric and eccentric implants for hamstring graft fixation. ANZ J Surg 2008;78:177-81.
13.	Hill PF, Russell VJ, Salmon LJ, Pinczewski LA. The influence of supplementary tibial fixation on laxity measurements after anterior cruciate ligament reconstruction with hamstring tendons in female patients. Am J Sports Med 2005;33:94-101.
14.	Teo WW, Yeoh CS, Wee TH. Tibial fixation in anterior cruciate ligament reconstruction: Is supplementary staple fixation necessary? J Orthopaed Surg 2017;25:2309499017699743.
15.	Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA. Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: Patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy 2005;21:412-7.
16.	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.
17.	Tetsumura S, Fujita A, Nakajima M, Abe M. Biomechanical comparison of different fixation methods on the tibial side in anterior cruciate ligament reconstruction: A biomechanical study in porcine tibial bone. J Orthop Sci 2006;11:278-82.
18.	Bauer LA, Alberti HA, Corotti VG, Franco AP, Stieven Filho E, Cunha LA. Biomechanical analysis of a double fixation method for tendon graft in porcine tibia – Using an interference screw plus staple. Rev Bras Ortop 2018;53:564-9.
19.	Pinczewski LA, Clingeleffer AJ, Otto DD, Bonar SF, Corry IS. Integration of hamstring tendon graft with bone in reconstruction of the anterior cruciate ligament. Arthroscopy 1997;13:641-3.
20.	Weiler A, Hoffmann RF, Bail HJ, Rehm O, Südkamp NP. Tendon healing in a bone tunnel. Part II: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy J Arthrosc Related Surg 2002;18:124-35.
21.	Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF. Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 1993;75:1795-803.
22.	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.

Advanced Biomedical Research