A randomized prospective controlled study with 5-year follow-up of cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction.
OBJECTIVE
The purpose of this study was to determine and compare mid- to long-term results of cross-pin versus metal interference screw fixation of ACL graft.


METHODS
In a prospective trial, 62 patients were randomized into two groups based on method of fixation. Transtibial drilling technique was used in the cross-pin and outside-in femoral drilling in the interference screw fixation group. Clinical and radiographical outcomes were assessed 2 and 5 years postoperatively.


RESULTS
The study showed no clinically significant difference with respect to method of graft fixation. Mean anteroposterior side-to-side instrumented laxity difference was 2.4 mm in the cross-pin group and 2.5 mm in the screw group (n.s.). Median Tegner and mean Lysholm scores at 5 years were 6 (range 3-9) and 92.2 (range 69-100) in the screw group and 7 (3-10) and 93.3 (82-100), respectively, in the cross-pin group. Radiographical osteoarthritis increased in both groups from 2 to 5 years after reconstruction (p < 0.05), especially in the medial and patellofemoral joint spaces. Widening of the drill tunnels continued from 2 to 5 years without clinical significance.


CONCLUSIONS
The method of graft fixation did not yield a difference in clinical or radiographical outcome at 5 years. Results were excellent in both groups.


METHODS
I.
Helsinki University Central Hospital, Helsinki, Finland. patrick.bjorkman@hus.fi.
Patrick
P
Björkman
ORTON Orthopaedic Hospital, Helsinki, Finland.
Jerker
J
Sandelin
ORTON Orthopaedic Hospital, Helsinki, Finland.
Arsi
A
Harilainen
D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation*; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007719:Knee Joint / Q000000981:diagnostic imaging; D065466:Lysholm Knee Score; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D013710:Tendons / Q000637:transplantation*; D055815:Young Adult