2023 ISAKOS Biennial Congress ePoster
No Difference in Clinical Outcomes Between Aperture And Suspensory Femoral-Sided Fixation Following Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Autograft
Garrison Hughes, BS, Falls Church, Virginia UNITED STATES
Cory Riccio, MD, Washington, DC UNITED STATES
Tarun Vippa, BS, Fairfax, Virginia UNITED STATES
Christopher M Kuenze, PhD, Charlottesville, VA UNITED STATES
Rachel E Cherelstein, BS, Arlington, VA UNITED STATES
Mitchell A Nader, , Fairfax, Virginia UNITED STATES
Laura Keeling, MD, Washington, DC UNITED STATES
Theodore N Rudic, BS, Fairfax, Virginia UNITED STATES
Kory BD Pasko, BS, Washington DC UNITED STATES
Edward S. Chang, MD, Washington, DC UNITED STATES
Inova, Fairfax, Virginia, UNITED STATES
FDA Status Not Applicable
Summary
A retrospective study comparing the effect of aperture vs suspensory fixation on patient-reported knee function and reinjury rate in young, active patients undergoing ACL reconstruction with BPTB autograft finds no significant difference in knee function or graft failure rate, suggesting that both fixation methods are suitable for this patient population.
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Abstract
Background
Anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) autograft has long been the gold standard in young athletes. Traditionally, aperture fixation using an interference screw is the most common method used to achieve femoral fixation. However, in recent years suspensory fixation utilizing an adjustable cortical button has gained prominence due to favorable healing and reduced iatrogenic injury during graft placement. However, little is known about the efficacy of suspensory fixation when using BPTB autograft.
Purpose
To compare the effect of femoral-sided fixation methods (interference screw vs. cortical button) on patient-reported knee function and reinjury rate in young, active patients undergoing ACLR with BPTB autograft.
Methods
A retrospective study was conducted in patients undergoing primary ACLR with BPTB autograft using either interference screw or cortical button fixation. All patients completed the International Knee Documentation Committee Subjective Knee Evaluation (IKDC) and reported secondary ACL injury (if present) via an online survey. Demographic characteristics and patient-reported outcome measures were compared between groups using independent samples t-test. Distribution of patient sex and graft failure was compared between groups using chi-square tests. A-priori alpha level was p<0.05.
Results
49 patients receiving cortical button and 24 patients receiving interference screw fixation were included in this analysis at an average of 30.4 months post-ACLR. Groups did not differ based on patient age (p= 0.15), sex (p= 0.56), nor body mass index (p= 0.47) (Table 1). There was no significant difference in IKDC score between groups (p= 0.73). There were 3 (6.1%) graft failures in the cortical button group and 2 (8.3%) in the interference screw group.
Conclusions
In patients undergoing ACLR with BPTB autograft, there were no significant differences between interference screw and cortical button fixation in the femur with respect to clinical outcomes or graft failure rates. This suggests that both methods are suitable for young, active patients.