Knee laxity in anterior cruciate ligament reconstruction. The influence of graft rotation using interference screw fixation

• Published in: Der Unfallchirurg 2014-09, Vol.117 (9), p.822-828
• Main Authors: Offerhaus, C, Balke, M, Braas, M, Pennig, D, Gick, S, Höher, J
• Format: Article
• Language: ger
• Subjects: Adult; Anterior Cruciate Ligament - diagnostic imaging; Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Bone Screws - adverse effects; Female; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Joint Instability - diagnostic imaging; Joint Instability - etiology; Joint Instability - surgery; Male; Radiography; Tendons - transplantation; Treatment Outcome
• ISSN: 1433-044X
• DOI: 10.1007/s00113-013-2420-3

The use of interference screws for femoral graft fixation in anterior cruciate ligament (ACL) reconstruction with hamstring grafts can result in rotation of the graft around the screw leading to changes in the final position of the graft within the bone tunnel. In a prospective study 107 patients (54 right and 53 left knees) underwent ACL reconstruction with a hamstring tendon autograft. Femoral fixation of the graft was performed with a standard right-thread screw in all cases. Patients were assessed at 6 months postoperatively with the international knee documentation committee (IKDC) standard evaluation including instrumented laxity measurements and the results were compared between right and left knees. A significantly higher postoperative anterior laxity was observed in left knees with a negative Lachman test in only 64 % of the cases compared with 87 % in the group of right knees. Accordingly, instrumented laxity measurements of the reconstructed knee compared with the contralateral knee revealed significant differences between left and right knees (left knees 1.8±1.2 mm and right knees 1.0±1.4 mm) This study demonstrates the importance of femoral graft positioning and its sensitivity to multiple influencing factors. The use of standard right-thread interference screws for femoral graft fixation in the mirrored situation of right and left knees may produce a systematic error in ACL reconstruction. Due to a possible rotation of the graft around the screw, the final position of the transplant may vary thus leading to significant changes in anterior translation of the operated knee.