Does Cortical Non-Contact or Delayed Contact of an Adjustable-loop Femoral Button Affect Knee Stability after ACL Reconstruction?

Transcription

1 Does Cortical Non-Contact or Delayed Contact of an Adjustable-loop Femoral Button Affect Knee Stability after ACL Reconstruction? Kim CK, Sohn SE, Koh IJ, Kim MS, Song KY, In Y Seoul St. Mary s Hospital The Catholic University of Korea

2 Conflict of interest Kim CK, MD. Sohn SE, MD. Koh IJ, MD, Ph.D Kim MS, MD. Song KY, MD. In Y, MD, Ph.D We have no financial conflicts to disclose. 2

3 Femoral Graft Fixation in ACL-R & Soft Tissue Interposition TightRope Cortical suspensory devices Adjustable-length loops Comparable good outcomes Biomechanical & Clinical A number of use is increasing TightRope has higher risk than Fixed-loop Longer loop No side trailing sutures Sonnery-Cottet;2014, Harato;2016 Early necrosis of interposed tissue Graft loosening : graft-tunnel motion Graft-to-bone healing Nag;2012, Sonnery-Cottet;2014

4 Cortical Non-contact Indirect evidence of soft tissue interposition Identifiable with radiograph Clinical relevance in single-bundle ACL reconstruction is not known yet

5 Purpose To identify Cortical Non-contact or Delayed contact of an adjustable-loop button for femoral fixation in anatomic single-bundle ACL reconstruction Affects Tunnel widening, Knee stability and Functional outcomes at minimum 2 years postoperatively

6 Subject & Study Design Retrospective study / May 2013 May 2016 / 80 Subjects Inclusion criteria Primary autogenous hamstring graft ACL-R using TightRope // Single-bundle & Anteromedial (AM) portal technique // Follow up > 2 years Exclusion criteria Previous HTO (high tibial osteotomy) // Early Re-rupture of graft Total 80 Contact 46 Non-contact 34 < Comparison 1. > Immediate postoperative Radiographs Delayed Contact 19 Persisting Non-Contact 15 < Comparison 2. > At 2-year postoperative Radiographs

7 Radiographic Evaluation < Comparison 1. > Contact vs Non-contact Contact Non-Contact Non-Contact : Gap distance > 1 mm < Comparison 2. > Delayed contact vs Persisting Non-contact Delayed contact Persisting Non-contact Immediate Postop 2Y Immediate Postop 2Y

8 Radiographic Evaluation Measurement of Tunnel Width F-AP F-Lat T-AP T-Lat Average width of 2 point measurement At Postoperative 2-year radiographs Knee stability Clinical Evaluation Side-to-side Difference : KT-1000 arthrometer (MEDmetric, San Diego, CA, USA) Functional outcomes Lysholm score / International Knee Documentation Committee (IKDC) score Independent t-test, chi-square test SPSS 21.0, p < 0.05 Statistical Analysis

9 Results of Comparison 1 Contact vs Non-contact * Graft size, mm Contact : 8.1 ± 0.7 (6-10) Non-contact : 7.9 ± 0.9 (6-9) (P-value : 0.490) Tunnel Width No difference between two groups Tunnel Widening No difference between two groups

10 Results of Comparison 1 Contact vs Non-contact Side-to-side Difference, mm No difference between two groups Contact (n = 46) Non-contact (n = 34) p-value 1.6 ± 0.9 (0-4) 1.5 ± 0.9 (0-4).667 Functional scores No difference between two groups 10

11 Results of Comparison 2 Delayed Contact vs Persisting Non-contact * Gap distance Delayed Contact : 1.8 ± 0.5 ( ) Persisting Non-contact : 2.1 ± 0.6 ( ) (P-value : 0.113) Tunnel Widening No difference between two groups Delayed Contact (n=19) Persisting Non-contact (n=15) p-value Clinical Outcomes KT-1000(difference), mm 1.5 ± 0.9 (0-4) 1.5 ± 1.1 (0-4).937 Lysholm score 94.6 ± 6.5 (75-100) 95.9 ± 4.7 (85-100).542 IKDC score 84.2 ±13.2 ( ) 87.9 ±9.3 ( )

12 Conclusion Cortical non-contact of the adjustable-loop button did not affect knee stability, radiographic outcomes, or clinical outcomes at a minimum follow-up of two years after surgery. Delayed contact patients were estimated to exhibit similar outcomes to Persisting non-contact patients. Surgeons should strive to obtain cortical contact of the adjustable-loop femoral button. Nevertheless, cortical noncontact with small gap distance (< 3 mm) may be tolerable following single-bundle autogenous hamstring ACL reconstruction.

13 Reference 1. Sonnery-Cottet B, Rezende FC, Martins Neto A, Fayard JM, Thaunat M, Kader DF. Arthroscopically confirmed femoral button deployment. Arthrosc Tech. 2014;3(3):e Harato K, Niki Y, Toyoda T, Kamata Y, Masumoto K, Otani T, Suda Y. Self-flip Technique of the TightRope RT Button for Soft-Tissue Anterior Cruciate Ligament Reconstruction. Arthrosc Tech. 2016;5(2):e Nag HL, Gupta H. Seating of TightRope RT Button Under Direct Arthroscopic Visualization in Anterior Cruciate Ligament Reconstruction to Prevent Potential Complications. Arthrosc Tech. 2012;1(1):e Mae T, Kuroda S, Matsumoto N, Yoneda M, Nakata K, Yoshikawa H, Shino K. Migration of EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(11): Marchant MH Jr, Willimon SC, Vinson E, Pietrobon R, Garrett WE, Higgins LD. Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8): Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med. 2004;32(2): Choi NH, Yang BS, Victoroff BN. Clinical and Radiological Outcomes After Hamstring Anterior Cruciate Ligament Reconstructions: Comparison Between Fixed-Loop and Adjustable-Loop Cortical Suspension Devices. Am J Sports Med. 2017;45(4):