Tibial fixation in anterior cruciate ligament reconstruction using soft-tissue allograft: Cortical suspensory device versus aperture interference screw.

Abstract

This study aimed to compare clinical outcomes and tibial tunnel widening following anterior cruciate ligament reconstruction (ACLR) using allo-tibialis tendon performed with an all-inside technique (All-inside group) or an aperture fixation technique with a bioabsorbable screw (Aperture fixation group) for tibial side fixation. A retrospective analysis of 36 patients between 2012 and 2022 was conducted. Patients who received a single-bundle anatomical ACLR with allo-tibialis tendon using suspensory femoral fixation were divided into two groups according to tibial fixation methods: adjustable suspensory fixative device or aperture fixation technique with a bioabsorbable screw. All-inside technique required a smaller skin incision (<5 mm) for tibial fixation. At postoperative 1-year radiographs, tunnel diameter showed no significant difference at the aperture level between both groups. More tunnel enlargement was observed in the All-inside group at the mid-substance level (P = 0.044). Postoperative 1-year MRI in the All-inside group showed a significantly larger cross-sectional area (CSA) at the aperture level than the mid-substance level (P = 0.003). CSA increments were larger in the All-inside group than the Aperture fixation group at insertion side and mid-substance level. No significant differences in clinical outcome measures were observed, including the Lysholm score, Tegner activity level. All-inside group showed higher failure cases and significantly lower rate of return to previous sports at postoperative 2-year follow up. All-inside technique with soft allograft demonstrated cosmetic superiority and non-inferior clinical outcomes at the median 2-year follow up but showed larger tibial tunnel widening than aperture fixation technique with a bioabsorbable interference screw at the postoperative 1-year follow up.