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Femoral Press-Fit Fixation Technique in Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Graft

A Prospective Clinical Evaluation of 285 Patients

Attila Pavlik, MD, PhD^*,, Péter Hidas, MD, PhD, András Tállay, MD, PhD, József Toman, MD and István Berkes, MD, PhD

From the National Institute for Sports Medicine, Department of Sports Surgery, Budapest, Hungary, and the Semmelweis University, Faculty of Sports Surgery and Rehabilitation, Budapest, Hungary

^* Address correspondence to Attila Pavlik, MD, PhD, Alkotás St. 48., 1123 Budapest, Hungary (e-mail: pavlika{at}t-online.hu).

Background: The security of the graft fixation is an important factor of anterior cruciate ligament reconstruction, especially in the early postoperative period.

Hypothesis: The femoral press-fit fixation technique is a safe, alternative technique for the fixation of the bone–patellar tendon–bone graft.

Study Design: Case series; Level of evidence, 4.

Methods: Between January 1, 1998, and June 30, 2002, 285 patients, with a mean age of 29.1 years, underwent operation and observation in our department. All patients had arthroscopic anterior cruciate ligament reconstruction using bone–patellar tendon–bone graft with femoral press-fit and tibial interference screw fixation. The mean follow-up period was 35.8 months (range, 24–77 months). During each patient’s evaluation, a physical examination, a subjective evaluation, the International Knee Documentation Committee and Lysholm scores, KT-1000 arthrometer testing, and radiological evaluation were performed. The paired Student t test or ² test was used for statistical analysis.

Results: According to the International Knee Documentation Committee score, 241 patients (85%) had good (46 normal and 195 nearly normal) results, whereas 39 patients had abnormal and 5 patients had severely abnormal overall results. The preoperative mean Lysholm score was 63.5 ± 12.7 points. At the final examination, the mean value was 93.5 ± 7.8 points (P < .01). One hundred ninety-seven athletes could return to their previous sports activity level, whereas 13 patients gave up their sports career. The KT-1000 arthrometer results showed a side-to-side difference of 1.91 ± 2.1 mm at the maximum manual strength tests.

Conclusion: The femoral press-fit fixation is an alternative fixation method for the bone–patellar tendon–bone graft and provides good stability for the anterior cruciate ligament reconstruction. The use of press-fit fixation technique avoids most interference screw or other hardware-induced complications at the femoral side.

Key Words: ACL reconstruction • patellar tendon • press-fit fixation • follow-up study