title: The influence of supplementary tibial fixation on laxity measurements after anterior cruciate ligament reconstruction with hamstring tendons in female patients.
abstract: BACKGROUND
  Female patients undergoing arthroscopic anterior cruciate ligament reconstruction with a hamstring tendon graft developed increased postoperative laxity compared to male and female patients who had reconstruction using a patellar tendon graft. This difference may be due to graft slippage in less dense female tibial bone.
  
  
  OBJECTIVE
  Reinforcement of tibial fixation of the hamstring tendon graft in women by supplementary methods may reduce laxity.
  
  
  METHODS
  Randomized controlled clinical trial; Level of evidence, 2.
  
  
  METHODS
  Fifty-six female patients divided into 2 groups (standard tibial fixation with 7 x 25-mm metal interference screw versus metal interference screw with supplementary staple fixation) were followed for 2 years.
  
  
  RESULTS
  After 2 years, the mean side-to-side difference using KT-1000 arthrometer manual maximum measurements was 1.8 mm (standard group) and 1.1 mm (staple group) (P=.05). The percentage of patients with a side-to-side difference of <3 mm did not differ significantly between the 2 groups (P=.66): 88.8% of the standard group versus 90.5% of the staple group. A grade 0 Lachman test result was present in 63% of the standard group and 86% of the staple group (P=.04). Kneeling pain was experienced by 7% of the standard group and 29% of the staple group (P=.05).
  
  
  CONCLUSIONS
  Supplementary tibial fixation in female patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft in addition to a single-size screw significantly improves laxity measurements and clinical stability assessment 2 years after surgery. However, this improvement is at the cost of increased kneeling pain.
authors.affiliation: Australian Institute of Musculo-Skeletal Research, New South Wales, Australia.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Hill
authors.forename: Vivianne J
authors.initials: VJ
authors.lastname: Russell
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Salmon
authors.forename: Leo A
authors.initials: LA
authors.lastname: Pinczewski
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001863:Bone Screws; D005260:Female; D006801:Humans; D007593:Joint Instability; D007718:Knee Injuries / Q000601:surgery*; D010329:Patella; D012737:Sex Factors; D013536:Suture Techniques; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome