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document
Intratunnel versus extratunnel autologous hamstring double-bundle graft for anterior cruciate ligament reconstruction : a comparison of 2 femoral fixation procedures . BACKGROUND Anatomic double-bundle anterior cruciate ligament ( ACL ) reconstruction provides excellent results for restoring normal kinematics to the knee . Nevertheless , strong evidence supporting an ideal method for fixation of the ACL graft is lacking . HYPOTHESIS Intratunnel femoral fixation of the ACL graft via a cross-pin fixation technique would provide better clinical and objective results than the extratunnel femoral fixation with cortical buttons . STUDY DESIGN Randomized clinical trial ; Level of evidence , 2 . METHODS Seventy patients with a unilateral ACL-deficient knee were randomly assigned to 1 of 2 femoral fixation groups . Group A ( 35 patients ) was fixed with 2 bioabsorbable Rigidfix pins , 1 cross-pin per bundle , while group B ( 35 patients ) was secured with 1 EndoButton cortical button per bundle . All femoral tunnels were created via an anteromedial portal , and a bioabsorbable Biointrafix interference screw was used for tibial fixation for both groups . The evaluation of the patients was performed by history details , clinical examination findings , measurement of the joint laxity by KT-1000 arthrometer , and use of validated patient outcome questionnaires . Statistical analysis was carried out with Fisher exact and Mann-Whitney U tests , with P < .05 considered the cutoff level of significance . RESULTS At a mean follow-up of 30 months , 34 and 32 patients of group A and B , respectively , were available for evaluation . There were no statistically significant differences between the treatment groups regarding the subjective and objective outcomes , except for KT-1000 arthrometer values . The median KT-1000 value of patients in the cross-pin fixation group was 1.30 mm , while the median value in the cortical button fixation group was 1.95 mm ( P < .001 ) . Four patients with ACL grafts that were fixed with cortical buttons demonstrated failure of stability via the instrumented knee laxity testing , while patients from the other group had no failures . CONCLUSION Intratunnel femoral fixation of the double-bundle ACL graft from the cross-pin fixation technique provided better instrumented knee laxity results than did the extratunnel femoral fixation with cortical buttons . Future larger studies comparing these 2 techniques should be conducted to ensure the availability of stronger evidence supporting the findings of this study .
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Intervention_Physical
Intratunnel versus extratunnel autologous hamstring double-bundle graft
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Intervention_Physical
Intratunnel femoral fixation of the ACL graft via a cross-pin fixation technique
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Intervention_Physical
extratunnel femoral fixation with cortical buttons
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Intervention_Physical
fixed with 2 bioabsorbable Rigidfix pins , 1 cross-pin per bundle , while group B ( 35 patients ) was secured with 1 EndoButton cortical button per bundle
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Intervention_Physical
KT-1000 arthrometer
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Intervention_Physical
cortical button fixation
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Intervention_Physical
cortical buttons
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Intervention_Physical
Intratunnel femoral fixation of the double-bundle ACL graft
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Intervention_Physical
extratunnel femoral fixation with cortical buttons .
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Outcome_Other
restoring normal kinematics to the knee
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Outcome_Other
median KT-1000 value
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Outcome_Physical
stability via the instrumented knee laxity testing
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Outcome_Physical
knee laxity