FEMORAL INTERFERENCE SCREW DIVERGENCE IN ANTERIOR CRUCIATE LIGAMENT (ACL) RECONSTRUCTION
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Keywords
Anterior Cruciate Ligament, Bone Screw, Bone-Patellar Tendon-Bone, Reconstruction
Abstract
Introduction: The interference screw is used to rigidly fix bone-patellar tendon-bone (B-PT-B) graft in anterior cruciate ligament (ACL) reconstruction. We hypothesized that interference screw placement through the patellar tendon (PT) portal (through donor defect) in a transtibially drilled femoral tunnel could be less divergent. We investigated the difference in divergence of interference screw placed through the PT portal and anteromedial (AM) portal and its clinical relevance.
Materials and Methods: In this prospective study, twelve patients underwent femoral tunnel B-PT-B graft fixation through AM portal (group 1) and the other 12 (group 2) through the PT portal. Femoral tunnel-interference screw divergence was measured on postoperative digital lateral X-rays. Ha’s method was used to grade divergence. The clinical outcome was assessed by postoperative intervention knee documentation committee grading (IKDC) and Lysholm score at two years of follow-up.
Results: Mean tunnel-screw divergence in sagittal plane through AM portal was 13.38o and through PT portal was 7.20o (P<0.0001). In the AM portal group, 82.9% of patients had divergence in either grade 3 or 4 categories, whereas, in the PT portal group, 82.9% were in grade 1 or 2 categories (P<0.0001). Mean Lysholm scores were 92.8 and 94.5 at two-year follow-up in both groups (P>0.05). The International knee documentation committee grades of patients in both groups were similar. Conclusion: Femoral interference screw placement through the PT portal leads to significantly less screw divergence than screw placement through the AM portal. However, this difference in divergence is not reflected in clinical outcomes.
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Soundar Manickam
Department of Orthopaedics, Faculty of Medicine – Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600095, India.
Satish Raj
Department of Orthopaedics, Faculty of Medicine – Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600095, India
Sathis Kumar G
Department of Orthopaedics, Faculty of Medicine – Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600095, India
Aakash Kannauh
Department of Orthopaedics, Faculty of Medicine – Sri Lalithambigai Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, Tamil Nadu 600095, India.