ACL Reconstruction Using Patellar Tendon Graft with Press Fit Fixation tied to Low Femoral Tunnel Widening Incidence

Femoral tunnel widening after ACL reconstruction is a common phenomenon. Miklós Tátrai et al conducted a study using a patellar tendon graft with a press-fit fixation technique without any fixation device in ACL reconstruction surgeries to find out if it reduces the incidence of femoral tunnel widening.

The study has been published in ‘Indian Journal of Orthopaedics.’

This study was conducted on 467 patients with ACL surgery. Two hundred and nineteen of them had an ACL surgery with patellar tendon (PT) graft, and two hundred and forty-eight of them with hamstring tendon (HS).

The bone–patellar tendon–bone graft was harvested with the technique in Pavlik et al. The most important step of this technique was to very accurately shape the patellar bone. It had a trapezoid form with most commonly 9 mm diameter at the end and 10 mm diameter at the base. In this case, the patellar bone block was impacted in the 9 mm wide femoral tunnel. The femoral tunnel and the patellar bone had the same length; hence the base of the patellar bone ft totally into the femoral tunnel, without any fixation device. The same technique was used with the trapezoid form at the tibial tunnel.

Exclusion criteria were history of previous ACL reconstruction of either knee, multiple ligament injury, or evidence of osteoarthritis on radiographs. The femoral tunnels were measured on the anteroposterior (AP) and lateral radiographs 6 months after the operation. Two independent orthopedic surgeons measured all radiographs twice and recorded the tunnel widenings.

Key findings of the study were:

• The mean incidence rate of the tunnel widening in the HS group was, on the AP and the lateral femoral views, 88% (n=217) and 83% (n=205), while in the PT group, 17% (n=37) and 2% (n=4), respectively.

• There was a significant difference both on AP and lateral radiographs (HS vs. PT: fem. AP: 89% vs. 17% p< 0.001; HS vs. PT: fem. lat: 84% vs. 2% p< 0.001).

The authors concluded that – “The femoral tunnel widening incidence rate during an ACL reconstruction is significantly less when using PT tendon with femoral press-fit fixation than when using HT tendon with suspensory fixation method.”

Further reading:

Low Femoral Tunnel Widening Incidence Rate After ACL Reconstruction Using Patellar Tendon Graft with Press Fit Fixation

Miklós Tátrai, Tamás Halasi et al

Indian Journal of Orthopaedics (2023) 57:596–602

https://doi.org/10.1007/s43465-023-00836-3