Press-fit fixation in anterior cruciate ligament reconstruction yields low graft failure and revision rates: a systematic review and meta-analysis

Purpose Press-fit fixation is a hardware-free technique in anterior cruciate ligament reconstruction (ACLR). The purpose of this review was to quantitatively assess the risk profile and outcomes of press-fit fixation and provide an update on its effectiveness compared to more standard fixation techn...

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Bibliographic Details
Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2021-06, Vol.29 (6), p.1750-1759
Main Authors: Shanmugaraj, Ajaykumar, Mahendralingam, Mathepan, Gohal, Chetan, Horner, Nolan, Simunovic, Nicole, Musahl, Volker, Samuelsson, Kristian, Ayeni, Olufemi R.
Format: Article
Language:English
Subjects:
Anterior cruciate ligament
Autografts
Biodegradability
Biodegradation
Bone grafts
Bone implants
Clinical trials
Enlargement
Failure analysis
Femur
Fixation
Graft rejection
Grafting
Interference
Knee
Ligaments
Medicine
Medicine & Public Health
Meta-analysis
Orthopedics
Ortopedi
Quality assessment
Reconstruction
Revisions
Risk assessment
Screws
Sports Medicine
Staples
Systematic review
Tunnels
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Summary:Purpose Press-fit fixation is a hardware-free technique in anterior cruciate ligament reconstruction (ACLR). The purpose of this review was to quantitatively assess the risk profile and outcomes of press-fit fixation and provide an update on its effectiveness compared to more standard fixation techniques of ACLR. Methods The electronic databases PUBMED, MEDLINE, and EMBASE were searched on March 26, 2020 for therapeutic randomized controlled trials (RCT) addressing press-fit fixation for primary ACLR. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the quality for randomized studies. A meta-analysis with a random-effects model was used to pool applicable outcomes data. Results A total of six eligible RCTs were included in this review. There were 292 patients (72.9% male) with a mean age of 28.8 ± 3.8 years and a mean follow-up of 81.3 ± 88.3 months that underwent press-fit ACLR on the femoral, tibial or both tunnels. Femoral fixation techniques included press-fit fixation (96.6%) and cross-pin fixation (3.4%). Tibial fixation techniques included press-fit (37.0%), staples (28.1%), interference screws (21.2%) and abarticular post-screws (13.7%). Graft options included bone–patellar tend–-bone autografts (73.6%) and semitendinosus and gracilis tendon autograft (26.4%). Significant improvements ( p  
ISSN:0942-2056
1433-7347
DOI:10.1007/s00167-020-06173-4