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Comparison of Three Techniques of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft

Differences in Anterior Tibial Translation and Tunnel Enlargement with Each Technique

From the Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan

^* Address correspondence and reprint requests to Yasuyuki Ishibashi, MD, Department of Orthopaedic Surgery, Hirosaki University, School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan

Background: Anatomic fixation of the graft in anterior cruciate ligament reconstruction has improved stability of the reconstructed knee joint in experimental studies.

Hypothesis: Anatomic fixation of the bone-patellar tendon-bone autograft will reduce tunnel enlargement and improve clinical results.

Study Design: Prospective cohort study.

Methods: Sixty patients were randomly divided into three groups: a nonanatomic fixation group (traditional single-incision reconstruction), an anatomic fixation group (reconstruction in which a bone plug was grafted into the tibial tunnel), and an anatomic fixation group with all-inside reconstruction. Stability of the knee joint was examined with a KT-1000 arthrometer at 2, 4, 6, 12, and 24 months after surgery. At 12 months, anteroposterior and lateral radiographs were made to assess tunnel enlargement.

Results: Although the magnitude of tibial displacement gradually increased after reconstruction in all three groups, the anatomic fixation group had significantly better stability than the groups undergoing nonanatomic fixation or all-inside anatomic fixation at 4 and 6 months after anterior cruciate ligament reconstruction. However, there was no significant difference between the three groups at 24 months. Regarding the tibial tunnel, residual rates and enlargement of tunnels were different between the reconstruction techniques. The nonanatomic reconstruction group had significantly greater tunnel enlargement.

Conclusion: Anatomic fixation of the graft decreased the tunnel enlargement but had no effect on knee stability at 2-year follow-up.

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