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Femoral Aperture Fixation Improves Anterior Cruciate Ligament Graft Function When Added to Cortical Suspensory Fixation: An In Vivo Computer Navigation Study

Porter, Mark D; Shadbolt, Bruce

Description

BACKGROUND Recommendations for bone tunnel placement during anterior cruciate ligament (ACL) reconstruction have become more precise. However, these recommendations differ neither with the choice of graft nor with the method of fixation used. The influence of the method of femoral fixation used on the biomechanical function of a soft tissue ACL graft remains unknown. HYPOTHESIS Our null hypothesis was that adding femoral aperture fixation to femoral cortical fixation, using the same bone...[Show more]

dc.contributor.authorPorter, Mark D
dc.contributor.authorShadbolt, Bruce
dc.date.accessioned2018-09-12T00:30:21Z
dc.date.available2018-09-12T00:30:21Z
dc.identifier.issn2325-9671
dc.identifier.urihttp://hdl.handle.net/1885/147360
dc.description.abstractBACKGROUND Recommendations for bone tunnel placement during anterior cruciate ligament (ACL) reconstruction have become more precise. However, these recommendations differ neither with the choice of graft nor with the method of fixation used. The influence of the method of femoral fixation used on the biomechanical function of a soft tissue ACL graft remains unknown. HYPOTHESIS Our null hypothesis was that adding femoral aperture fixation to femoral cortical fixation, using the same bone tunnels, will not alter the control of anterior translation (AT) and internal rotation (IR) during ACL reconstruction using a hamstring graft. STUDY DESIGN Controlled laboratory study. METHODS A total of 22 patients with an acute isolated ACL rupture underwent reconstruction using a single-bundle autologous hamstring graft. Computer navigation was used intraoperatively to plot the AT and IR during the pivot-shift test before reconstruction, after ACL reconstruction using cortical suspensory fixation, and after the addition of femoral aperture fixation. Statistical analysis (analysis of variance) was used to compare the AT and IR during the pivot shift at each stage in the procedure. RESULTS Before ACL reconstruction, the mean (±SD) AT was 14.2 ± 7.3 mm and mean IR was 17.2° ± 5.5°. After reconstruction using femoral cortical suspension, these figures were significantly reduced to 6.2 ± 3.5 mm and 12.5° ± 3.20°, respectively (P < .001). The addition of the aperture fixation was associated with a further significant reduction to 4.6 ± 3.2 mm and 10.4° ± 2.7°, respectively (P < .001). CONCLUSION The addition of femoral aperture fixation to suspensory fixation results in a significant reduction in both the AT and IR that occurs during the pivot-shift assessment immediately after ACL reconstruction using autologous hamstring graft. CLINICAL RELEVANCE The most precise positioning of bone tunnels during soft tissue ACL reconstruction needs to take into consideration the type of fixation being used.
dc.format6 pages
dc.format.mimetypeapplication/pdf
dc.publisherSAGE Publications (UK and US)
dc.rights© The Author(s) 2016. This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/ licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
dc.sourceOrthopaedic journal of sports medicine
dc.subjectACL
dc.subjectcomputer navigation
dc.subjectfemoral fixation
dc.subjectpivot shift
dc.titleFemoral Aperture Fixation Improves Anterior Cruciate Ligament Graft Function When Added to Cortical Suspensory Fixation: An In Vivo Computer Navigation Study
dc.typeJournal article
local.identifier.citationvolume4
dc.date.issued2016-09-01
local.publisher.urlhttps://au.sagepub.com/en-gb/oce/home
local.type.statusPublished Version
local.contributor.affiliationShadbolt, Bruce, ANU Medical School, CHM ANU Medical School, The Australian National University
local.identifier.essn2325-9671
local.bibliographicCitation.issue9
local.bibliographicCitation.startpage2325967116665795
local.identifier.doi10.1177/2325967116665795
dcterms.accessRightsOpen Access
CollectionsANU Research Publications

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