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First published on December 9, 2004, doi:10.1177/0363546504268036
This version was published on January 1, 2005
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The American Journal of Sports Medicine 33:94-101 (2005)
© 2005 American Orthopaedic Society for Sports Medicine

The Influence of Supplementary Tibial Fixation on Laxity Measurements After Anterior Cruciate Ligament Reconstruction With Hamstring Tendons in Female Patients

Peter F. Hill, MChir, FRCS, Vivianne J. Russell, BSc, Lucy J. Salmon, BAppSci and Leo A. Pinczewski, FRACS*

From the Australian Institute of Musculo-Skeletal Research, New South Wales, Australia

* Address correspondence to Leo A. Pinczewski, FRACS, 286 Pacific Highway, Crows Nest NSW 2065, Australia (e-mail lpinczewski{at}nsosmc.com.au).

Background: Female patients undergoing arthroscopic anterior cruciate ligament reconstruction with a hamstring tendon graft developed increased postoperative laxity compared to male and female patients who had reconstruction using a patellar tendon graft. This difference may be due to graft slippage in less dense female tibial bone.

Hypothesis: Reinforcement of tibial fixation of the hamstring tendon graft in women by supplementary methods may reduce laxity.

Study Design: Randomized controlled clinical trial; Level of evidence, 2.

Methods: Fifty-six female patients divided into 2 groups (standard tibial fixation with 7 x 25–mm metal interference screw versus metal interference screw with supplementary staple fixation) were followed for 2 years.

Results: After 2 years, the mean side-to-side difference using KT-1000 arthrometer manual maximum measurements was 1.8 mm (standard group) and 1.1 mm (staple group) (P = .05). The percentage of patients with a side-to-side difference of <3 mm did not differ significantly between the 2 groups (P = .66): 88.8% of the standard group versus 90.5% of the staple group. A grade 0 Lachman test result was present in 63% of the standard group and 86% of the staple group (P = .04). Kneeling pain was experienced by 7% of the standard group and 29% of the staple group (P = .05).

Conclusions: Supplementary tibial fixation in female patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft in addition to a single-size screw significantly improves laxity measurements and clinical stability assessment 2 years after surgery. However, this improvement is at the cost of increased kneeling pain.

Key Words: fixation • hamstring • anterior cruciate ligament (ACL) • laxity • female patients




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