Purpose
To compare all-inside cortical-button suspensory fixation in sockets versus interference
screw fixation in tunnels with respect to clinical, histologic, and biomechanical
assessments of all–soft tissue (AST) tendon autografts used for anterior cruciate
ligament (ACL) reconstruction in a canine model.
Methods
By use of a validated “hybrid” double-bundle ACL reconstruction technique (reconstruction
of the anteromedial bundle with preservation of the native posterolateral bundle),
dogs were randomly assigned to undergo either suspensory fixation in sockets (n =
6) or interference screw fixation in tunnels (n = 6). Contralateral knees were used
as nonoperated controls (n = 12). Quadrupled extensor tendon autografts were used
for both ACL reconstruction groups. Dogs were assessed radiographically and functionally
and humanely euthanized at 12 weeks after surgery for arthroscopic, gross, biomechanical,
and histologic assessments.
Results
Histologic assessments showed significantly (P = .018) better graft incorporation with 4-zone direct healing to bone for the grafts
using suspensory fixation in sockets (16.3 ± 1.5) compared with the grafts using interference
screw fixation in tunnels (14.2 ± 2.1). Furthermore, graft healing to bone was significantly
better at the aperture (P = .05) and mid-socket (P = .01) location for the group that underwent suspensory fixation in sockets (16.1
± 1.8 and 16.4 ± 1.9, respectively).
Conclusions
Suspensory fixation of AST grafts in sockets was associated with superior tendon-to-bone
healing compared with interference screw fixation in tunnels, with 4-zone direct graft
healing to bone seen for femoral and tibial sockets only in the suspensory-fixation
group. Biomechanical properties were similar between groups.
Clinical Relevance
These data provide evidence suggesting that an all-inside ACL reconstruction technique
using adjustable-loop cortical-button suspensory fixation in bone sockets has potential
clinical advantages for ACL reconstruction using AST grafts.
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Article info
Publication history
Published online: February 04, 2016
Accepted:
November 5,
2015
Received:
March 10,
2015
Footnotes
The authors report the following potential conflict of interest or source of funding: P.A.S. receives support from Arthrex and Spinal Simplicity. J.P.S. receives support from Arthrex; AO Board of Trustees; AO Research Review Commission; Orthopaedic Trauma Association; editor-in-chief, Journal of Knee Surgery; DePuy Synthes (A Johnson & Johnson Company); Smith & Nephew; Regeneration Technologies; and Thieme Medical Publishers (from textbook sales). F.M.P. receives support from Arthrex. K.K. receives support from Arthrex. C.C.B. receives support from Arthrex. J.L.C. receives support from Arthrex, Journal of Knee Surgery editorial board, Clinical Orthopaedics and Related Research editorial board, Schwartz Biomedical, Pivot Medical, National Institutes of Health, Arthrex, Zimmer, Smith & Nephew, Musculoskeletal Transplant Foundation, Stryker, Nutramax, MicroAire Surgical Instruments, University of Missouri, and Thieme (publishing).
Identification
Copyright
© 2016 by the Arthroscopy Association of North America
