Objectives To compare the rate of initial fixation failure and clinical outcomes in anterior cruciate ligament reconstruction (ACL-R) surgery with a rectangular tunnel bone-patellar tendon-bone (RT-BTB) graft (RT-BTB ACL-R) using metallic interference screws (M-IFSs) and bioabsorbable interference screws (B-IFSs) for femoral fixation.
Methods Data were prospectively collected from patients undergoing RT-BTB ACL-R and CT within 2 weeks after surgery. Femoral fixation was performed using M-IFSs (M-IFS group) or B-IFSs (B-IFS group). Screw selections were historically controlled. The following parameters were intraoperatively assessed: IFS breakage and initial fixation failure examined by movement of the graft pulled with maximum manual force. Posterior wall breakage was assessed using CT. Lysholm Score, the 2000 International Knee Documentation Committee Knee Examination Form and the KT-2000 arthrometer was evaluated as the clinical outcome measures.
Results The study included 116 patients. Of these, 26 were included in the M-IFS group and 92 in the B-IFS group. The rate of IFS breakage was not significantly different between the M-IFS and B-IFS groups (0.0% vs 2.2%). The rate of initial fixation failure was not significantly different between the M-IFS and B-IFS groups (3.8% vs 5.6%). Logistic regression analysis revealed that only posterior wall breakage predicted initial fixation failure (p=0.02). No significant difference of the clinical outcomes was observed between the M-IFS and B-IFS groups.
Conclusion Initial fixation failure or clinical outcomes is not different between M-IFS and B-IFS use for femoral fixation in RT-BTB ACL-R.
Level of evidence Prospective study using historical controls, level IV.
- anterior cruciate ligament reconstruction
- rectangular tunnel
- bone-patella tendon-bone
- bio-absorbable interference screw
- screw breakage
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Contributors KS wrote the initial draft of the manuscript. TS designed the study and contributed to analysis and interpretation of data and assisted in the preparation of the manuscript. All other authors have contributed to data collection and interpretation, and critically reviewed the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Not required.
Ethics approval This study was approved by the institutional review board of the Sapporo Medical University School of Medicine (282-215), Sapporo, Hokkaido, Japan.
Provenance and peer review Not commissioned; externally peer reviewed.
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