title: [Biodegradable screw versus a press-fit bone plug fixation for ACL reconstruction: a prospective randomized study].
abstract: BACKGROUND
  Press-fit fixation of a tendon graft has been advocated in order to achieve tendon to bone healing.
  
  
  OBJECTIVE
  Fixation of a tendon graft with a porous bone scaffold limits bone tunnel enlargement compared with a biodegradable interference screw fixation.
  
  
  METHODS
  Between 2005 and 2006, 20 patients (17 men, 3 women) were enrolled in this study for primary reconstruction of the ACL. Patients were randomized to either obtain graft fixation in the tibial tunnel by means of an interference screw (I) or a press-fit fixation with a porous bone cylinder (P). Three months after surgery, a CT scan of the knee was performed and tunnel enlargement was analysed in the coronal and sagittal planes for the proximal, middle and distal thirds of the tunnel. After 6 months, 1 and 2 years, International Knee Documentation Committee (IKDC), Tegner and Lysholm scores of both groups were compared.
  
  
  RESULTS
  The bone tunnel enlargement was 106.9±10.9% for group P and 121.9±9.0% for group I (P<0.02) in the AP plane and 102.8±15.2% vs 121.5±10.1% in the coronal plane (P<0.01). IKDC, Tegner, and Lysholm scores improved in both groups from pre- to postoperative assessment without significant differences between the two groups. There was a trend to higher knee stability in group P after 3 months (0.6±1.4 mm vs 1.81±.5 mm, P=0.08).
  
  
  CONCLUSIONS
  Both interference screw and a press-fit fixation lead to a high number of good or very good outcomes after ACL reconstruction. Tibial press-fit fixation decreases the amount of proximal bone tunnel enlargement. Press-fit fixation decreases the amount of proximal bone tunnel enlargement and improves bone to tendon contact.
authors: Abteilung Orthopädie/Unfallchirurgie/Sportmedizin, Agnes-Karll-Krankenhaus, Laatzen, Hildesheimer Straße 158, 30880, Laatzen, Deutschland. Bjoern.Geiges@krh.eu
authors: B
authors: B
authors: Geiges
authors: C
authors: C
authors: von Falck
authors: K
authors: K
authors: Knobloch
authors: C
authors: C
authors: Haasper
authors: R
authors: R
authors: Meller
authors: C
authors: C
authors: Krettek
authors: S
authors: S
authors: Hankemeier
authors: J
authors: J
authors: Brand
authors: M
authors: M
authors: Jagodzinski
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000000981:diagnostic imaging / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation* / Q000379:methods; D001863:Bone Screws; D018786:Bone Substitutes / Q000627:therapeutic use*; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D018786:Bone Substitutes