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

Written By : Dr Supreeth D R |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-06-25T20:00:09+05:30 | Updated On 27 Jun 2023 3:36 PM IST

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.”

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751