Advanced Biomedical Research

Anterior cruciate ligament reconstruction using autologous hamstring single-bundle Rigidfix technique compared with single-bundle Transfix technique

Authors

Department of Orthopedics, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Initial fixation strength is critical for the early post-operative rehabilitation of patients with anterior cruciate ligament (ACL) reconstructions. However, even the best femoral fixation devices remain controversial. We compared the results of 2 of the femoral fixation techniques,Rigidfix and Transfix.
Materials and Methods: A total of 30 patients with unilateral ACL deficiency were randomly assigned to 1 of 2 groups. In Group A an anatomic single-bundle ACL reconstruction was performed using Rigidfix technique(Mitek, Norwood,MA), Group B were treated by a single bundle using Transfix technique(Arthrex, Naples, FL, USA). For tibial fixation, a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. The patients were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman's and the pivot-shift tests. They also completed the International Knee Documentation Committee (IKDC) score.
Results: At a mean of 14 months (12-17) followup there were no significant differences concerning time between injury and range of movement between the 2 groups. However, the Rigidfix group showed significantly better results for the subjective assessment of knee function ( P = 0.002). The Lachman, anterior drawer, and pivot-shift tests also showed no significant difference between the 2 groups. The IKDC scale showed no significant difference among the groups ( P < 0.001).There was no difference regarding duration of operation and cost of the operation between the 2 groups.On clinical evaluation there was no significant difference between the 2 groups. However, regardless of the technique, all knees were improved by ACL reconstruction compared with their preoperative status.
Conclusion: Both techniques can be used for reconstruction of ACL. Other factors, such as psychic profile of the patients should be considered for surgery planning.

Keywords

1. Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: A national population-based study. J Sci Med Sport 2009;12:622-7.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2. Graham SM, Parker RD. Anterior cruciate ligament reconstruction using hamstring tendon grafts. Clin Orthop Relat Res 2002;402:64-75.  Back to cited text no. 2
[PUBMED]    
3. Gabriel MT, Wong EK, Wood SL, Yagi M, Debski RE. Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 2004;22:85-9.  Back to cited text no. 3
    
4. Woo SL, Kanamori A, Zeminski J. The effectiveness of reconstruction of the anterior cruciate ligament with hamstring and patellar tendon: A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am 2002;84-A:907-14.  Back to cited text no. 4
    
5. Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y. Reconstruction of the anterior cruciate ligament. Single-versus double multistranded hamstring tendons. J Bone Joint Surg Br 2004;86:515-20.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6. Cha PS, Brucker PU, West RV, Zelle BA, Yagi M, Kurosaka M, et al. Arthroscopic double-bundle anterior cruciate ligament reconstruction: An anatomic approach. Arthroscopy 2005;21:1275.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7. Hamada M, Shino K, Horibe S. Single- versus bi-socket anterior cruciate ligament reconstruction using autogenous multiple stranded hamstring tendons with endobutton femoral fixation: A prospective study. Arthroscopy 2001;17:801-7.  Back to cited text no. 7
    
8. Hara K, Kubo T, Suginoshita T, Shimizu C, Hirasawa T. Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy 2000;16:860-4.  Back to cited text no. 8
    
9. Marcacci M, Molgota AP, Zaffaginini S. Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy 2003;19:536-40.  Back to cited text no. 9
    
10. Muneta T, Sekiya I, Yagishia K. Two bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with Endobuttons: Operative technique and preliminary results. Arthroscopy 1999;15:618-24.  Back to cited text no. 10
    
11. Pinczewski LA, Deehan DJ, Salman LJ, Russell VJ, Clingeletter A. A five year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 2002;30:523-36.  Back to cited text no. 11
    
12. Ahmad CS, Gardner TR, Groh M, Arnouk J, Levine WN. Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction. Am J Sports Med 2004;32:635-40.  Back to cited text no. 12
[PUBMED]  [FULLTEXT]  
13. Kousa P, Jarvinen TL, Vihavainen M, Kannus P, Jarvinen 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.  Back to cited text no. 13
    
14. Zantop T, Weimann A, Rummler M, Hassenpflug J, Petersen W. Initial fixation strength of two bioabsorbable pins for the fixation of hamstring grafts compared to interference screw fixation: Single cycle and cyclic loading. Am J Sports Med 2004;32:641-9.  Back to cited text no. 14
    
15. Harilainen A, Sandelin J. A Prospective Comparison of 3 Hamstring ACL Fixation Devices-Rigidfix, BioScrew, and Intrafix-Randomized Into 4 Groups With 2 Years of Follow-Up. Am J Sports Med 2009;37:699-706.  Back to cited text no. 15
[PUBMED]  [FULLTEXT]  
16. Wu JL, Yeh TT, Shen HC, Cheng CK, Lee CH. Mechanical comparison of biodegradable femoral fixation devices for hamstring tendon graft: A biomechanical study in a porcine model. Clin Biomech (Bristol, Avon) 2009;24:435-40.  Back to cited text no. 16
[PUBMED]  [FULLTEXT]  
17. Halewood C, Hirschmann MT, Newman S, Hleihil J, Chaimski G, Amis AA. The fixation strength of a novel ACL soft-tissue graft fixation device compared with conventional interference screws: A biomechanical study in vitro. Knee Surg Sports Traumatol Arthrosc 2010;19:559-67.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  
18. Seo SS, Kim CW, Nam TS, Choi SY. ACL Reconstruction with Autologous Hamstring Tendon: Comparison of Short Term Clinical Results between Rigid-fix and PINN-ACL Cross Pin. Knee Surg Relat Res 2011;23:208-12.  Back to cited text no. 18
[PUBMED]  [FULLTEXT]  
Advanced Biomedical Research
Volume 2012, July
July 2012
Pages 1-4