title: Anatomic versus non-anatomic tibial fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft.
abstract: We prospectively compared two series of 30 anterior cruciate ligament (ACL) reconstructions each where the bone-patellar tendon-bone graft was alternately fixed at the level of the tibial plateau (group A; anatomic fixation) or distal to the plateau level (group B; non-anatomic fixation). In group A, a 35-mm-long tibial tuberosity bone block was harvested. The distal 10-15 mm were resected and fixed proximally to the undersurface of the tendon to shorten it. After an average 18 months' follow-up, there were no significant differences between the two groups concerning subjective evaluation, symptoms, range of motion and objective stability. Tibial tuberosity pain was more frequent in group A (53% vs 17%, P = 0.01). Radiographic evaluation showed that tibial tunnel enlargement was less frequent in group A (23% vs 43%, P = 0.02). There was no correlation between tunnel enlargement and objective stability. In conclusion, fixation of the graft at the tibial plateau level did not improve objective stability in this study. Because of the greater technical difficulty and occurrence of tibial tuberosity pain, this technique is not recommended.
authors.affiliation: II Clinica Ortopedica, Università di Firenze, Florence, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Aglietti
authors.forename: G
authors.initials: G
authors.lastname: Zaccherotti
authors.forename: A J
authors.initials: AJ
authors.lastname: Simeone
authors.forename: R
authors.initials: R
authors.lastname: Buzzi
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain; D010329:Patella; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery / Q000637:transplantation*; D016896:Treatment Outcome