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Clinical Comparison of Fixation Methods for Patellar Bone Quadriceps Tendon Autografts in Anterior Cruciate Ligament Reconstruction

Absorbable Cross-pins Versus Absorbable Screws

Ottmar Gorschewsky, MD^,*, Robert Stapf, MD, Laurent Geiser, Ulrich Geitner and Wolfram Neumann, MD

From the Sportorthopädie Bern, Klinik Sonnenhof, Bern, Switzerland, Universität Bern, Bern, Switzerland, and Orthopädische Universitätsklinik Magdeburg, Magdeburg, Germany

^* Address correspondence to Ottmar Gorschewsky, MD, Sportorthopädie Bern, Klinik Sonnenhof, Buchserstrasse 30, CH-3006 Bern, Switzerland (e-mail: ottmargorschewsky{at}sonnenhof.ch).

Background: Recently, the use of the quadriceps tendon transplant with bone block (patellar bone quadriceps tendon autografts) for anterior cruciate ligament reconstruction has increasingly been reported.

Hypothesis: Clinical results after the implantation of a patellar bone quadriceps tendon autograft fixed with cross-pins or screws will show no significant difference between the 2 techniques with regard to stability, function, and subjective satisfaction.

Study Design: Cohort study; Level of evidence, 2.

Methods: Between 1998 and 2004, 193 patients with anterior cruciate ligament ruptures were implanted with a patellar bone quadriceps tendon autograft. For 100 of these patients, fixation was carried out using absorbable cross-pins, and for the remaining 93, fixation was carried out using absorbable screws. The results were evaluated by means of International Knee Documentation Committee, Noyes, and Lysholm scores, as well as KT-1000 arthrometer measurement and subjective satisfaction.

Results: The mean follow-up postoperative control period was 29 months. In the International Knee Documentation Committee overall evaluation, the pin group showed a significantly better result (P =.03). The values of the Noyes score produced no significant differences. The mean value of the Lysholm score was 94 points in the screw group and 89 points in the pin group (P <.001). Overall, 90% of the patients subjectively judged their conditions as good or very good.

Conclusion: With both operating processes examined, 80% to 90% of the cases achieved good to very good results. The use of cross-pins can be recommended for fixing patellar bone quadriceps tendon autografts.

Key Words: rupture of the anterior cruciate ligament • operative care • cross-pins • patellar bone quadriceps tendon • autograft