title: Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies.
abstract: The purpose of our study was that to systematically review the fixation techniques for the ACL reconstruction and associated clinical outcomes at the early follow-up. Systematic search on three electronic databases (Cochrane register, Medline and Embase) of fixation devices used for primary ACL reconstruction with doubled semitendinosus and gracilis and bone-patellar tendon-bone autografts in randomized clinical trials of level I and II of evidence published from January 2001 to December 2011. Therapeutic studies collected were with a minimum 12-month follow-up, and the clinical outcomes were evaluated by at least one of International Knee Documentation Committee, Lysholm and Tegner functional scales and at least one of the following knee stability tests: arthrometric AP tibial translation, Lachman test and pivot-shift test. Nineteen articles met the inclusion criteria. At the femoral side cross-pin, metallic interference screw, bioabsorbable interference screw, and suspensory device were used in 32.3, 27.3, 24.8, 15.5% of patients, respectively. At the tibial side fixation was achieved with metallic interference screw, bioabsorbable interference screw, screw and plastic sheath, screw post and cross-pin in 38.7, 31, 15.7, 12.8, and 1.7% of patients, respectively. Side-to-side anterior-posterior tibial translation was 1.9 ± 0.9, 1.5 ± 0.9, 1.5 ± 0.8, 2.2 ± 0.4 mm for metallic interference screw, bioabsorbable screw, cross-pin and suspensory device, respectively. At least two-third of all the patients achieved good-to-excellent clinical outcomes. Rate of failure was 6.1, 3.3, 1.7 and 1.2% for bioabsorbable interference screw, metallic interference screw, cross-pin and suspensory device, respectively. Clinical outcomes are good to excellent in almost two-third of the patients but several pitfalls that affect the current fixation techniques as graft tensioning such as graft-tunnel motion are still unaddressed.
authors.affiliation: Institute of Orthopedics and Traumatology, Catholic University, 'Agostino Gemelli' Hospital, Rome, Italy, andrea.speziali@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Speziali
authors.forename: Marco
authors.initials: M
authors.lastname: Delcogliano
authors.forename: Matteo
authors.initials: M
authors.lastname: Tei
authors.forename: Giacomo
authors.initials: G
authors.lastname: Placella
authors.forename: Matteo
authors.initials: M
authors.lastname: Bartoli
authors.forename: Amerigo
authors.initials: A
authors.lastname: Menghi
authors.forename: Giuliano
authors.initials: G
authors.lastname: Cerulli
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic