Ju. Buelow et al., A new bicortical tibial fixation technique in anterior cruciate ligament reconstruction with quadruple hamstring graft, KNEE SURG S, 8(4), 2000, pp. 218-225
We report a prospective series of 101 patients receiving a four-strand semi
tendinosus-gracilis autograft for anterior cruciate ligament reconstruction
using a new bicortical tibial fixation technique with bioabsorbable interf
erence screws. Patients (average age 32 years) were operated on between Nov
ember 1997 and Mai 1998, and follow-up was at least 12 months postoperative
ly. The evaluation consisted of history, clinical examination, IKDC score,
Cincinnati Knee Score, KT-1000 testing, standardized radiography and magnet
ic resonance imaging. One hundred patients were available for follow-up. Th
ere were two traumatic reruptures 6 and 11 months postoperatively. By IKDC
score 87 patients were in groups A and B, 12 in group C, and 2 with a rerup
ture in group D. Mean Cincinnati Knee Score was 82 (range 46-100), KT-1000
manual maximum at follow-up showed an average difference of 1.7 mm between
the sides. Full extension was rapidly achieved in all cases, and flexion av
eraged 135 degrees. Considering the enlargement caused by the bioabsorbable
interference screws, the incidence of tunnel widening was 6.6% on the femo
ral side and 1.7% on the tibial side. Tunnel widening did not affect the cl
inical results. Three patients experienced an effusion after more than 6 mo
nths postoperatively. There was one infection, which settled without functi
onal impairment after early arthroscopic lavage and intravenous antibiotics
. Otherwise no complications occurred. The described technique for anterior
cruciate ligament reconstruction combines the advantage of anatomical graf
t position with sufficient graft fixation. A short intra-articular graft co
nstruct with a strong tendon to bone interface was created. Clinically, 87%
of patients had a normal or nearly normal IKDC score at follow-up. Magneti
c resonance imaging revealed a considerable increase in tunnel area caused
by the insertion of the interference screws. On the ether hand, the develop
ment of a "fibrous interzone" between the graft and the bone tunnel was pre
vented in most cases. At short-term follow-up the bicortical tibial fixatio
n proved to be efficient even with an aggressive rehabilitation program.