Excellent bone plug–socket integration at 8 weeks after anterior cruciate ligament reconstruction using an adjustable-length loop cortical fixation device. Issue 1 (8th February 2019)

• Record Type: Journal Article
• Authors: Uchida, Ryohei; Nakamura, Norimasa; Suzuki, Tomoyuki; Kusano, Masashi; Mae, Tatsuo; Ohzono, Kenji; Toritsuka, Yukiyoshi
• Is Part Of: Journal of ISAKOS. Volume 4:Issue 1(2019)
• Page Start: 9
• Page End: 14
• Publication Date: 2019-02-08
• Subjects: knee -- Ct-scan -- acl / pcl -- bone; Joints -- Endoscopic surgery -- Periodicals; Osteoarthritis -- Periodicals; Joints -- Diseases -- Periodicals; Total knee replacement -- Periodicals; Sports injuries -- Surgery -- Periodicals; Sports medicine -- Periodicals; 617.472059705
• DOI: 10.1136/jisakos-2018-000244
• Languages: English
• ISSNs: 2059-7754

Abstract

Abstract : Objectives: Recently, adjustable-length loop cortical fixation devices (ALCFDs) have been developed. However, they are not frequently used for bone–patellar tendon–bone (BTB) grafting, mainly because it is uncertain whether an ALCFD enables sufficient integration of the bone plug. Thus, the purpose of this study was to evaluate bone plug–socket integration in anterior cruciate ligament reconstruction (ACL-R) with an ALCFD. Methods: Twenty consecutive patients with a mean age of 25±10 years underwent primary anatomic rectangular tunnel (ART) ACL-R with a BTB graft using BTB TightRope. The operated knees were evaluated by CT at 4 weeks and 8 weeks postoperatively. Union between the bone plug and the socket wall were assessed on 30 evaluation planes. No border between the plug and the socket wall, or trabecular continuity, were defined as complete union and a visible gap of >1 mm as incomplete union. When complete union was observed on >20, 11–20, 5–10 or <5 of the evaluation planes, bone integration was graded as excellent, good, fair or poor, respectively. In addition, the interface area between the plug and the socket wall was assessed by CT value index. Clinical evaluation was performed at 2 years postoperatively using the International Knee Documentation Committee (IKDC) form. Results: The proportion of patients with excellent bone integration was 20% at 4 weeks and 85% at 8 weeks, showing a significant difference (p=0.00015). Moreover, the CT value index of the interface area at 4 weeks was 25.8%±11.8% and that at 8 weeks was 15.3%±9.0%, again showing a significant difference (p=0.005). These suggest that bone integration of the interface area progresses over time and adequate at 8 weeks. Clinically, all 16 patients examined directly were rated their knees as normal or nearly normal with a mean side-to-side difference in anterior laxity at manual maximum force by KT-2000 of 0.2±0.3 mm. Conclusion: Excellent bone plug–socket integration was observed at 8 weeks after ART ACL-R using an ALCFD with satisfactory clinical results. An ALCFD could be safely applied for ART ACL-R. Level of evidence: 4 (case series).