title: Intratunnel versus extratunnel fixation of hamstring autograft for anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  To determine which is more effective: intratunnel or extratunnel anterior cruciate ligament soft-tissue graft fixation. A secondary purpose was to determine whether groups displayed differing relations between objective International Knee Documentation Committee (IKDC) grade and the timing of full weight bearing (FWB), jogging/running, and return to sports. The study hypotheses were that intratunnel fixation would display a greater percentage of normal or nearly normal objective IKDC grades and enable earlier FWB, return to jogging/running, and return to sports.
  
  
  METHODS
  We performed a systematic review of prospective, Studies with Level I or II evidence published from 2000 to 2011 with at least 2 years' follow-up that used interference screw hamstring autograft fixation (intratunnel group) or button, staple, or post hamstring autograft fixation (extratunnel group) for primary anterior cruciate ligament reconstruction. We also compared IKDC grades; Tegner and Lysholm scores; instrumented anterior laxity and pivot-shift test findings; timing of FWB, jogging/running, and return to sports; and modified Coleman Methodology Scores.
  
  
  RESULTS
  The groups showed comparable modified Coleman Methodology Scores, objective IKDC grades, Lysholm and Tegner scores, instrumented anterior laxity and pivot-shift test findings, and return-to-sports timing. The intratunnel group displayed earlier FWB and jogging/running; however, return-to-sports timing did not differ between groups. Early FWB and the percentage of patients with normal or nearly normal objective IKDC grades were directly related for the extratunnel group.
  
  
  CONCLUSIONS
  Patients who received intratunnel fixation were released earlier to FWB and jogging/running, supporting the study hypotheses. Groups did not differ in return-to-sports timing or objective IKDC grades, not supporting the study hypotheses. Early FWB in the extratunnel group was related to a greater percentage of patients having normal or nearly normal objective IKDC grades. Return-to-sports timing and having a normal objective IKDC grade were related in both groups; however, this relation was stronger with intratunnel fixation.
  
  
  METHODS
  Level II, systematic review of Level I and II studies.
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky 40202, USA.
authors.forename: Dave Lee Yee
authors.initials: DL
authors.lastname: Han
authors.forename: John
authors.initials: J
authors.lastname: Nyland
authors.forename: Matthew
authors.initials: M
authors.lastname: Kendzior
authors.forename: Akbar
authors.initials: A
authors.lastname: Nawab
authors.forename: David N M
authors.initials: DN
authors.lastname: Caborn
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery*; D014182:Transplantation, Autologous; D055815:Young Adult