COMPARATIVE STUDY ON CHONDRAL INJURIES VIA DIFFERENT APPROACHES TO RECONSTRUCT anterior cruciate ligament USING Rigidfix FEMORAL FIXATION DEVICE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 HUANGChangming , FANHuaqiang , FUYangpan , DONGHuixiang , TANGCong

Department of Orthopaedics, the 174th Hospital of Chinese PLA & Affiliated Chenggong Hospital of Xiamen University, Xiamen Fujian, 361003, P. R. China;

Corresponding author：

HUANGChangming, Email: huangchm123@163.com

Keywords：

Anterior cruciate ligament reconstruction; Rigidfix femoral fixation device; Anteromedial approach; Tibial tunnel approach; Chondral injury; Applied anatomy

DOI：

10.7507/1002-1892.20140150

Video：

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Objective To compare the incidence of chondral injury using Rigidfix femoral fixation device via the anteromedial approach and the tibial tunnel approach during anterior cruciate ligament (ACL) reconstruction. Methods Eighteen adult cadaver knees were divided randomly into 2 groups, 9 knees in each group. Femoral tunnel drilling and cross-pin guide insertions were performed using the Rigidfix femoral fixation device through the anteromedial approach (group A) and the tibial tunnel approach (group B). ACL reconstruction simulation was performed at 0, 10, 20, 30, 45, 60, 70, 80, and 90°in the horizontal position. The correlation between incidence of chondral injury and slope angles was analyzed, and then the incidence was compared between the 2 groups. Results The correlation analysis indicated that the chondral injury incidence increased with the increasing of the slope angle (r=0.611, P=0.000; r=0.852, P=0.000). The incidence of chondral injury was 69.1% (56/81) and 48.1% (39/81) in groups A and B respectively, showing significant difference (χ²=7.356, P=0.007). The sublevel analysis showed that the chondral injury incidence of group A (36.1%, 13/36) was significantly higher than that of group B (0) at 0-30°(χ²=15.864, P=0.000), but no significant difference was found between group A (95.6%, 43/45) and group B (86.7%, 39/45) at 45-90°(P=0.267). Conclusion It has more risk of chondral injury to use Rigidfix femoral fixation device via the anteromedial approach than the tibial tunnel approach to reconstruct ACL.

Citation： HUANGChangming, FANHuaqiang, FUYangpan, DONGHuixiang, TANGCong. COMPARATIVE STUDY ON CHONDRAL INJURIES VIA DIFFERENT APPROACHES TO RECONSTRUCT anterior cruciate ligament USING Rigidfix FEMORAL FIXATION DEVICE. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(6): 677-680. doi: 10.7507/1002-1892.20140150 Copy

1.	Sabat D, Kundu K, Arora S, et al. Tunnel widening after anterior cruciate ligament reconstruction:a prospective randomized computed tomography-based study comparing 2 different femoral fixation methods for hamstring graft. Arthroscopy, 2011, 27(6):776-783.
2.	Choi NH, Yoo SY, Victoroff BN. Tibial tunnel widening after hamstring anterior cruciate ligament reconstructions:comparison between Rigidfix and Bio-TransFix. Knee, 2013, 21(1):31-35.
3.	Bellisari GE, Kaeding CC, Litsky AS. Mechanical evaluation of cross pins used for femoral fixation of hamstring grafts in ACL reconstructions. Orthopedics, 2010, 33(10):722.
4.	Chechik O, Amar E, Khashan M, et al. An international survey on anterior cruciate ligament reconstruction practices. Int Orthop, 2013, 37(2):201-206.
5.	Hensler D, Working ZM, Illingworth KD, et al. Medial portal drilling:effects on the femoral tunnel aperture morphology during anterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2011, 93(22):2063-2071.
6.	Kopf S, Forsythe B, Wong AK, et al. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg (Am), 2010, 92(6):1427-1431.
7.	Hantes ME, Zachos VC, Liantsis A, et al. Differences in graft orientation using the transtibial and anteromedial portal technique in anterior cruciate ligament reconstruction:a magnetic resonance imaging study. Knee Surg Sports Traumatol Arthrosc, 2009, 17(8):880-886.
8.	Hantes ME, Dailiana Z, Zachos VC, et al. Anterior cruciate ligament reconstruction using the Bio-TransFix femoral fixation device and anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc, 2006, 14(5):497-501.
9.	Castoldi F, Bonasia DE, Marmotti A, et al. ACL reconstruction using the Rigidfix femoral fixation device via the anteromedial portal:a cadaver study to evaluate chondral injuries. Knee Surg Sports Traumatol Arthrosc, 2008, 16(3):275-278.
10.	Chang CB, Yoo JH, Chung BJ, et al. Oblique femoral tunnel placement can increase risks of short femoral tunnel and cross-pin protrusion in anterior cruciate ligament reconstruction. Am J Sports Med, 2010, 38(6):1237-1245.
11.	Loh JC, Fukuda Y, Tsuda E, et al. Knee stability and graft function following anterior cruciate ligament reconstruction:comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Arthroscopy, 2003, 19(3):297-304.
12.	Scopp JM, Jasper LE, Belkoff SM, et al. The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy, 2004, 20(3):294-299.
13.	Nishimoto K, Kuroda R, Mizuno K, et al. Analysis of the graft bending angle at the femoral tunnel aperture in anatomic double bundle anterior cruciate ligament reconstruction:a comparison of the transtibial and the far anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3):270-276.
14.	Dargel J, Schmidt-Wiethoff R, Fischer S, et al. Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction:a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3):220-227.
15.	Gelber PE, Reina F, Torres R, et al. Anatomic single-bundle anterior cruciate ligament reconstruction from the anteromedial portal:evaluation of transverse femoral fixation in a cadaveric model. Arthorscopy, 2010, 26(5):651-657.
16.	Gelber PE, Reina F, Torres R, et al. Effect of femoral tunnel length on the safety of anterior cruciate ligament graft fixation using cross-pin technique:a cadaveric study. Am J Sports Med, 2010, 38(9):1877-1884.
17.	McGlaston TJ, Entezari V, Nazarian A, et al. The safe zone for TransFix fixation in anterior cruciate ligament reconstruction using the anteromedial portal technique. Arthroscopy, 2011, 27(1):77-82.
18.	Krupp R, Scovell F, Cook C, et al. Femoral cross-pin safety in anterior cruciate ligament reconstruction as a function of femoral tunnel position and insertion angle. Arthroscopy, 2011, 27(1):83-88.
19.	Kim JG, Lee YS, Ha JK, et al. Influence of knee flexion and femoral cross-pin insertion angle on posterolateral structures of the knee and lateral fixation lengths during ACL reconstruction. Surg Radiol Anat, 2012, 34(5):421-425.

1. Sabat D, Kundu K, Arora S, et al. Tunnel widening after anterior cruciate ligament reconstruction:a prospective randomized computed tomography-based study comparing 2 different femoral fixation methods for hamstring graft. Arthroscopy, 2011, 27(6):776-783.
2. Choi NH, Yoo SY, Victoroff BN. Tibial tunnel widening after hamstring anterior cruciate ligament reconstructions:comparison between Rigidfix and Bio-TransFix. Knee, 2013, 21(1):31-35.
3. Bellisari GE, Kaeding CC, Litsky AS. Mechanical evaluation of cross pins used for femoral fixation of hamstring grafts in ACL reconstructions. Orthopedics, 2010, 33(10):722.
4. Chechik O, Amar E, Khashan M, et al. An international survey on anterior cruciate ligament reconstruction practices. Int Orthop, 2013, 37(2):201-206.
5. Hensler D, Working ZM, Illingworth KD, et al. Medial portal drilling:effects on the femoral tunnel aperture morphology during anterior cruciate ligament reconstruction. J Bone Joint Surg (Am), 2011, 93(22):2063-2071.
6. Kopf S, Forsythe B, Wong AK, et al. Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg (Am), 2010, 92(6):1427-1431.
7. Hantes ME, Zachos VC, Liantsis A, et al. Differences in graft orientation using the transtibial and anteromedial portal technique in anterior cruciate ligament reconstruction:a magnetic resonance imaging study. Knee Surg Sports Traumatol Arthrosc, 2009, 17(8):880-886.
8. Hantes ME, Dailiana Z, Zachos VC, et al. Anterior cruciate ligament reconstruction using the Bio-TransFix femoral fixation device and anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc, 2006, 14(5):497-501.
9. Castoldi F, Bonasia DE, Marmotti A, et al. ACL reconstruction using the Rigidfix femoral fixation device via the anteromedial portal:a cadaver study to evaluate chondral injuries. Knee Surg Sports Traumatol Arthrosc, 2008, 16(3):275-278.
10. Chang CB, Yoo JH, Chung BJ, et al. Oblique femoral tunnel placement can increase risks of short femoral tunnel and cross-pin protrusion in anterior cruciate ligament reconstruction. Am J Sports Med, 2010, 38(6):1237-1245.
11. Loh JC, Fukuda Y, Tsuda E, et al. Knee stability and graft function following anterior cruciate ligament reconstruction:comparison between 11 o'clock and 10 o'clock femoral tunnel placement. Arthroscopy, 2003, 19(3):297-304.
12. Scopp JM, Jasper LE, Belkoff SM, et al. The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy, 2004, 20(3):294-299.
13. Nishimoto K, Kuroda R, Mizuno K, et al. Analysis of the graft bending angle at the femoral tunnel aperture in anatomic double bundle anterior cruciate ligament reconstruction:a comparison of the transtibial and the far anteromedial portal technique. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3):270-276.
14. Dargel J, Schmidt-Wiethoff R, Fischer S, et al. Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction:a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3):220-227.
15. Gelber PE, Reina F, Torres R, et al. Anatomic single-bundle anterior cruciate ligament reconstruction from the anteromedial portal:evaluation of transverse femoral fixation in a cadaveric model. Arthorscopy, 2010, 26(5):651-657.
16. Gelber PE, Reina F, Torres R, et al. Effect of femoral tunnel length on the safety of anterior cruciate ligament graft fixation using cross-pin technique:a cadaveric study. Am J Sports Med, 2010, 38(9):1877-1884.
17. McGlaston TJ, Entezari V, Nazarian A, et al. The safe zone for TransFix fixation in anterior cruciate ligament reconstruction using the anteromedial portal technique. Arthroscopy, 2011, 27(1):77-82.
18. Krupp R, Scovell F, Cook C, et al. Femoral cross-pin safety in anterior cruciate ligament reconstruction as a function of femoral tunnel position and insertion angle. Arthroscopy, 2011, 27(1):83-88.
19. Kim JG, Lee YS, Ha JK, et al. Influence of knee flexion and femoral cross-pin insertion angle on posterolateral structures of the knee and lateral fixation lengths during ACL reconstruction. Surg Radiol Anat, 2012, 34(5):421-425.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARATIVE STUDY ON CHONDRAL INJURIES VIA DIFFERENT APPROACHES TO RECONSTRUCT anterior cruciate ligament USING Rigidfix FEMORAL FIXATION DEVICE

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