Hybrid tibial fixation for anterior cruciate ligament reconstruction with Achilles tendon allograft.
OBJECTIVE
To compare clinical outcomes of tibial fixation between a biodegradable interference screw only and a biodegradable interference screw supplemented by a post-tie using a washer screw in single-bundle anterior cruciate ligament (ACL) reconstruction with 2-strand free tendon Achilles allograft in active young men.


METHODS
A prospective study was performed in 80 subjects who underwent single-bundle ACL reconstruction. A 2-strand free tendon Achilles allograft fixed with an EndoButton (Smith & Nephew, Andover, MA) in the femoral tunnel and with a Bio-Interference screw (Arthrex, Naples, FL) in the tibial tunnel was used in group I. Supplementary fixation was performed with a post-tie using a washer screw in group II. The Lachman test, pivot-shift test, International Knee Documentation Committee classification, Lysholm score, range of knee motion, and side-to-side difference were evaluated preoperatively and at the last follow-up. The Tegner activity scale was evaluated before injury and at the last follow-up. The 1-leg hop test was assessed at the last follow-up.


RESULTS
Of the patients, 36 in group I and 35 in group II could be followed up for at least 2 years. At the last follow-up, 7 patients in group I and 1 in group II showed a 2+ or 3+ on the Lachman test (P = .027). The mean side-to-side difference was 2.9 ± 2.3 mm in group I and 1.4 ± 1.6 mm in group II at the last follow-up (P = .002). The other clinical outcomes were not significantly different between the 2 groups.


CONCLUSIONS
Supplementary tibial fixation with a post-tie in ACL reconstruction using 2-strand free tendon Achilles allograft was more effective than a biodegradable interference screw only in restoration of the anterior stability of the tibia.


METHODS
Level II, randomized controlled trial.
Kangwon National University Hospital, Chuncheon, South Korea.
Jung Ho
JH
Noh
Bo Gyu
BG
Yang
Seung Rim
SR
Yi
Young Hak
YH
Roh
Jun Suk
JS
Lee
D000125:Achilles Tendon / Q000637:transplantation*; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001863:Bone Screws; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013977:Tibia / Q000601:surgery*; D014184:Transplantation, Homologous; D055815:Young Adult