Femoral cross-pin breakage and its effects on the results of anterior cruciate ligament reconstruction using a hamstring autograft.
OBJECTIVE
The primary aim was to determine the rate and risk factors of double biodegradable femoral cross-pin breakage after anterior cruciate ligament reconstruction using a hamstring autograft. In addition, we compared clinical outcomes and magnetic resonance imaging (MRI) findings related to grafts for knees with and without a broken cross-pin.


METHODS
A retrospective review of 53 knees (53 patients) was performed. Cross-pin breakage was determined by follow-up MRI. Age, sex, weight, height, presence of a posterior transcortical cross-pin breach, time between surgery and follow-up MRI, graft diameter, and cross-pin position (superior or inferior) were included in the analysis. Differences in Lysholm knee scores, International Knee Documentation Committee grades, anterior laxity, and pivot-shift test results were examined in relation to cross-pin breakage. In addition, anterior cruciate ligament graft integrity and osseous graft integration by MRI were assessed and compared between knees with broken cross-pins and knees with intact cross-pins.


RESULTS
A cross-pin was broken in 25 of 53 knees. A cross-pin posterior transcortical breach was the only factor found to be significantly correlated with cross-pin breakage (odds ratio, 6.117; P = .033) by univariate analysis. No significant differences in clinical outcomes were found to be related to cross-pin breakage, but femoral tunnel enlargement was more frequent in knees with breakage than in those without (P = .002).


CONCLUSIONS
Breakage of biodegradable cross-pins used for femoral fixation is relatively common but did not affect clinical outcomes. However, femoral tunnel enlargement was found to be greater in knees with a broken cross-pin. The only significant relation found was between a cross-pin posterior transcortical breach and breakage, which suggests that pin breakage is related to a technical error. These findings should be borne in mind when a double biodegradable cross-pin is being considered for femoral fixation.


METHODS
Level IV, therapeutic case series.
Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jin Hwan
JH
Ahn
Seung Ah
SA
Lee
Sang-Hee
SH
Choi
Joon Ho
JH
Wang
Jae Chul
JC
Yoo
Sung Sahn
SS
Lee
Moon Jong
MJ
Chang
D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation*; D001858:Bone Nails; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005269:Femur; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D007719:Knee Joint; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D016017:Odds Ratio; D016348:Osseointegration; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult