Combined Femoral Fixation Tecnique in Hamstring Tendon Anterior Cruciate Ligament Reconstruction: Asessment of Tunnel Widening

Purpose - to assess the influence of combined femoral fixation technique during arthroscopic ACL reconstruction on the femoral tunnel widening at long term follow-up. Material and methods. 99 patients with primary hamstring tendon (HT) ACL reconstruction performed in 2007- 2008 were analyzed. In the study group (42 patients) on the femoral side a combined cortical suspension (Endobutton CL, Smith & Nephew) and transverse (Rigid Fix, Depuy Mitek) fixation of graft was used. In control group, isolated cortical suspension fixation (Endobutton CL, Smith & Nephew) was used. On the tibial side for graft fixation a biodegradable screw (Biointrafix, DePuy Mitek) was used in all cases. Tunnel widening was calculated in percentage against primary tunnel diameter created during the surgery. MRI data were exported to eFilm (Merge Healthcare software), measurement of femoral tunnel diameters was performed on T1 sequences in coronal and sagittal planes on three different levels. Results. The mean age at the last follow up in the study group was 38.9 +/- 1.4, in control group - 38,6 +/- 1,08. The median time from surgery to follow up was 9 years and 4 months in the study group and 8 years 7 months in the controls. The incidence of graft failure in the study group was reported as 14.3%, while in the control group as 17,5%. The median femoral tunnel widening was larger in the control group at the joint aperture and midsection levels both in coronal and sagittal plane, although there was no statistically significant differences (p > 0,05). Conclusion. The combination of cortical suspension and transverse HT femoral graft fixation technique is likely to reduce tunnel enlargement at the long term follow-up. However further research and larger sample groups are required.