Clinical results of hamstring autografts in anterior cruciate ligament reconstruction: a comparison of femoral knot/press-fit fixation and interference screw fixation.
OBJECTIVE
To compare the clinical outcomes of femoral knot/press-fit anterior cruciate ligament (ACL) reconstruction with conventional techniques using femoral interference screws.


METHODS
Among patients who underwent arthroscopic ACL reconstruction with hamstring autografts, 73 were treated with either a femoral knot/press-fit technique (40 patients, group A) or femoral interference screw fixation (33 patients, group B). The clinical results of the 2 groups were retrospectively compared. The inclusion criteria were primary ACL reconstruction in active patients. The exclusion criteria were fractures, multiligamentous injuries, patients undergoing revision, or patients with contralateral ACL-deficient knees. In the femoral knot/press-fit technique, semitendinosus and gracilis tendons were prepared as 2 loops with knots. After passage through a bottleneck femoral tunnel, the grafts were fixed with a press-fit method (grafts' knots were stuck in the bottleneck of the femoral tunnel). A tie with Mersilene tape (Ethicon, Somerville, NJ) over a bone bridge for each tendon loop and an additional bioabsorbable interference screw were used for tibial fixation.


RESULTS
The mean follow-up period was 38 months (range, 24 to 61 months). A significant improvement in knee function and symptoms was reported in most patients, as shown by improved Tegner scores, Lysholm knee scores, and International Knee Documentation Committee assessments (P < .01). The results of instrumented laxity testing, thigh muscle assessment, and radiologic assessment were clearly improved when compared with the preoperative status (P < .01). No statistically significant difference in outcomes could be observed between group A and group B (P = not significant).


CONCLUSIONS
In this nonrandomized study, femoral knot/press-fit ACL reconstruction did not appear to provide increased anterior instability compared with that of conventional femoral interference screw ACL reconstruction. Favorable outcomes with regard to knee stability and patient satisfaction were achieved in most of our ACL-reconstructed patients using femoral knot/press-fit fixation with hamstring tendon autograft.


METHODS
Level IV, therapeutic case series.
Department of Orthopedic Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan.
Wei-Pin
WP
Ho
Department of Orthopedic Surgery, Taipei Medical University, Taipei, Taiwan.
Chian-Her
CH
Lee
Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan.
Chang-Hung
CH
Huang
Department of Orthopedic Surgery, Taipei Medical University, Taipei, Taiwan.
Chih-Hwa
CH
Chen
Department of Orthopedic Surgery, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan. Electronic address: ctycgmh@gmail.com.
Tai-Yuan
TY
Chuang
D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods* / Q000534:rehabilitation; D064592:Autografts; D001863:Bone Screws; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D013536:Suture Techniques; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery; D014182:Transplantation, Autologous; D055815:Young Adult