title: Comparison of three techniques of anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. Differences in anterior tibial translation and tunnel enlargement with each technique.
abstract: BACKGROUND
  Anatomic fixation of the graft in anterior cruciate ligament reconstruction has improved stability of the reconstructed knee joint in experimental studies.
  
  
  OBJECTIVE
  Anatomic fixation of the bone-patellar tendon-bone autograft will reduce tunnel enlargement and improve clinical results.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Sixty patients were randomly divided into three groups: a nonanatomic fixation group (traditional single-incision reconstruction), an anatomic fixation group (reconstruction in which a bone plug was grafted into the tibial tunnel), and an anatomic fixation group with all-inside reconstruction. Stability of the knee joint was examined with a KT-1000 arthrometer at 2, 4, 6, 12, and 24 months after surgery. At 12 months, anteroposterior and lateral radiographs were made to assess tunnel enlargement.
  
  
  RESULTS
  Although the magnitude of tibial displacement gradually increased after reconstruction in all three groups, the anatomic fixation group had significantly better stability than the groups undergoing nonanatomic fixation or all-inside anatomic fixation at 4 and 6 months after anterior cruciate ligament reconstruction. However, there was no significant difference between the three groups at 24 months. Regarding the tibial tunnel, residual rates and enlargement of tunnels were different between the reconstruction techniques. The nonanatomic reconstruction group had significantly greater tunnel enlargement.
  
  
  CONCLUSIONS
  Anatomic fixation of the graft decreased the tunnel enlargement but had no effect on knee stability at 2-year follow-up.
authors.affiliation: Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Otsuka
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tsuda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Sasaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Toh
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001863:Bone Screws; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010329:Patella / Q000601:surgery*; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome