Femoral tunnel-interference screw divergence in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft

A comparison of two techniques

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Interference screw is a popular fixation device used to rigidly fix bone-patellar tendon-bone (B-PT-B) graft both in femoral and tibial tunnels in anterior cruciate ligament (ACL) reconstruction. Parallel placement of screw is difficult in transtibially drilled femoral tunnel but always desired as it affects pullout strength of the graft. Commonly, interference screw into the femoral tunnel is inserted through the anteromedial (AM) or accessory AM portal. These portals are not-in-line with the transtibially drilled femoral tunnel. Furthermore, these portals increase the divergence of the interference screw in the femoral tunnel. We hypothesized that interference screw placement through patellar tendon (PT) portal (through donor defect) in transtibially drilled femoral tunnel can be less divergent. We report the prospective randomized study to investigate the difference of divergence of interference screw placed through PT portal and AM portal and its clinical relevance. Materials and Methods : Forty-one patients underwent femoral tunnel B-PT-B graft fixation through AM portal (group 1) and other 41 (group 2) through PT portal. Femoral tunnel-interference screw divergence was measured on postoperative digital lateral X-rays. Ha′s method was used to grade divergence. The clinical outcome was assessed by postoperative intervention knee documentation committee grading (IKDC) and Lysholm score at 2 years followup. Results: Mean tunnel-screw divergence in sagittal plane through AM portal was 13.38 o (95% CI: 12.34-14.41) and through PT portal was 7.20 o (95% CI: 6.25-8.16) (P<0.0001). In AM portal group, 82.9% patients had divergence in either grade 3 or 4 category, whereas in PT portal group, 82.9% patients were in grade 1 or 2 category (P<0.0001). Mean Lysholm score were 92.8 and 94.5 at two-year follow-up in both groups which were statistically not significant. The International knee documentation committee grades of patients in both groups were similar and had no statistical significance. Conclusion: Femoral interference screw placement through the PT portal leads to significantly less screw divergence as compared with screw placement through the AM portal. However, this difference in divergence is not reflected in clinical outcome.

Original languageEnglish
Pages (from-to)255-260
Number of pages6
JournalIndian Journal of Orthopaedics
Volume45
Issue number3
DOIs
Publication statusPublished - 05-2011

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Bone-Patellar Tendon-Bone Grafts
Anterior Cruciate Ligament Reconstruction
Thigh
Patellar Ligament
Documentation
Knee

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine

Cite this

@article{e45206b204694005a5daf80978cc9755,
title = "Femoral tunnel-interference screw divergence in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: A comparison of two techniques",
abstract = "Background: Interference screw is a popular fixation device used to rigidly fix bone-patellar tendon-bone (B-PT-B) graft both in femoral and tibial tunnels in anterior cruciate ligament (ACL) reconstruction. Parallel placement of screw is difficult in transtibially drilled femoral tunnel but always desired as it affects pullout strength of the graft. Commonly, interference screw into the femoral tunnel is inserted through the anteromedial (AM) or accessory AM portal. These portals are not-in-line with the transtibially drilled femoral tunnel. Furthermore, these portals increase the divergence of the interference screw in the femoral tunnel. We hypothesized that interference screw placement through patellar tendon (PT) portal (through donor defect) in transtibially drilled femoral tunnel can be less divergent. We report the prospective randomized study to investigate the difference of divergence of interference screw placed through PT portal and AM portal and its clinical relevance. Materials and Methods : Forty-one patients underwent femoral tunnel B-PT-B graft fixation through AM portal (group 1) and other 41 (group 2) through PT portal. Femoral tunnel-interference screw divergence was measured on postoperative digital lateral X-rays. Ha′s method was used to grade divergence. The clinical outcome was assessed by postoperative intervention knee documentation committee grading (IKDC) and Lysholm score at 2 years followup. Results: Mean tunnel-screw divergence in sagittal plane through AM portal was 13.38 o (95{\%} CI: 12.34-14.41) and through PT portal was 7.20 o (95{\%} CI: 6.25-8.16) (P<0.0001). In AM portal group, 82.9{\%} patients had divergence in either grade 3 or 4 category, whereas in PT portal group, 82.9{\%} patients were in grade 1 or 2 category (P<0.0001). Mean Lysholm score were 92.8 and 94.5 at two-year follow-up in both groups which were statistically not significant. The International knee documentation committee grades of patients in both groups were similar and had no statistical significance. Conclusion: Femoral interference screw placement through the PT portal leads to significantly less screw divergence as compared with screw placement through the AM portal. However, this difference in divergence is not reflected in clinical outcome.",
author = "Vivek Pandey and Kiran Acharya and Sharath Rao and Sripathi Rao",
year = "2011",
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doi = "10.4103/0019-5413.80045",
language = "English",
volume = "45",
pages = "255--260",
journal = "Indian Journal of Orthopaedics",
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T1 - Femoral tunnel-interference screw divergence in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft

T2 - A comparison of two techniques

AU - Pandey, Vivek

AU - Acharya, Kiran

AU - Rao, Sharath

AU - Rao, Sripathi

PY - 2011/5

Y1 - 2011/5

N2 - Background: Interference screw is a popular fixation device used to rigidly fix bone-patellar tendon-bone (B-PT-B) graft both in femoral and tibial tunnels in anterior cruciate ligament (ACL) reconstruction. Parallel placement of screw is difficult in transtibially drilled femoral tunnel but always desired as it affects pullout strength of the graft. Commonly, interference screw into the femoral tunnel is inserted through the anteromedial (AM) or accessory AM portal. These portals are not-in-line with the transtibially drilled femoral tunnel. Furthermore, these portals increase the divergence of the interference screw in the femoral tunnel. We hypothesized that interference screw placement through patellar tendon (PT) portal (through donor defect) in transtibially drilled femoral tunnel can be less divergent. We report the prospective randomized study to investigate the difference of divergence of interference screw placed through PT portal and AM portal and its clinical relevance. Materials and Methods : Forty-one patients underwent femoral tunnel B-PT-B graft fixation through AM portal (group 1) and other 41 (group 2) through PT portal. Femoral tunnel-interference screw divergence was measured on postoperative digital lateral X-rays. Ha′s method was used to grade divergence. The clinical outcome was assessed by postoperative intervention knee documentation committee grading (IKDC) and Lysholm score at 2 years followup. Results: Mean tunnel-screw divergence in sagittal plane through AM portal was 13.38 o (95% CI: 12.34-14.41) and through PT portal was 7.20 o (95% CI: 6.25-8.16) (P<0.0001). In AM portal group, 82.9% patients had divergence in either grade 3 or 4 category, whereas in PT portal group, 82.9% patients were in grade 1 or 2 category (P<0.0001). Mean Lysholm score were 92.8 and 94.5 at two-year follow-up in both groups which were statistically not significant. The International knee documentation committee grades of patients in both groups were similar and had no statistical significance. Conclusion: Femoral interference screw placement through the PT portal leads to significantly less screw divergence as compared with screw placement through the AM portal. However, this difference in divergence is not reflected in clinical outcome.

AB - Background: Interference screw is a popular fixation device used to rigidly fix bone-patellar tendon-bone (B-PT-B) graft both in femoral and tibial tunnels in anterior cruciate ligament (ACL) reconstruction. Parallel placement of screw is difficult in transtibially drilled femoral tunnel but always desired as it affects pullout strength of the graft. Commonly, interference screw into the femoral tunnel is inserted through the anteromedial (AM) or accessory AM portal. These portals are not-in-line with the transtibially drilled femoral tunnel. Furthermore, these portals increase the divergence of the interference screw in the femoral tunnel. We hypothesized that interference screw placement through patellar tendon (PT) portal (through donor defect) in transtibially drilled femoral tunnel can be less divergent. We report the prospective randomized study to investigate the difference of divergence of interference screw placed through PT portal and AM portal and its clinical relevance. Materials and Methods : Forty-one patients underwent femoral tunnel B-PT-B graft fixation through AM portal (group 1) and other 41 (group 2) through PT portal. Femoral tunnel-interference screw divergence was measured on postoperative digital lateral X-rays. Ha′s method was used to grade divergence. The clinical outcome was assessed by postoperative intervention knee documentation committee grading (IKDC) and Lysholm score at 2 years followup. Results: Mean tunnel-screw divergence in sagittal plane through AM portal was 13.38 o (95% CI: 12.34-14.41) and through PT portal was 7.20 o (95% CI: 6.25-8.16) (P<0.0001). In AM portal group, 82.9% patients had divergence in either grade 3 or 4 category, whereas in PT portal group, 82.9% patients were in grade 1 or 2 category (P<0.0001). Mean Lysholm score were 92.8 and 94.5 at two-year follow-up in both groups which were statistically not significant. The International knee documentation committee grades of patients in both groups were similar and had no statistical significance. Conclusion: Femoral interference screw placement through the PT portal leads to significantly less screw divergence as compared with screw placement through the AM portal. However, this difference in divergence is not reflected in clinical outcome.

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