TY - JOUR
T1 - Subcortical Backup Fixation in ACL Reconstruction
AU - Gee, Shawn M.
AU - Zhou, Liang
AU - Donohue, Michael A.
AU - Posner, Matthew A.
N1 - Funding Information:
The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Publisher Copyright:
© 2021
PY - 2022/2
Y1 - 2022/2
N2 - Anterior cruciate ligament (ACL) injuries result in knee instability in a majority of patients. Repair and reconstruction techniques have continually evolved over the past several decades. ACL reconstruction outcomes are directly impacted by physical therapy with early range of motion, weightbearing, and progressive strengthening. Therefore, the fixation must be sufficient to withstand the tensile and shear stresses across the graft construct during the biological healing phase. Occasionally, the primary fixation device is not strong enough to withstand these stresses. In turn, supplementary fixation devices, which are important especially in cases of revision ACL reconstruction, are imperfect. They occasionally become symptomatic, requiring hardware removal. Posts and washers require bicortical fixation, with moderate-sized holes in the tibia. Biocomposite screws rely on friction in the bone–screw interface, making them susceptible to failure. Tensioning can be problematic with the use of a post-and-washer construct. Subcortical fixation, which has not previously been described as a backup fixation method, provides several advantages. It requires a smaller, unicortical hole and provides fixation with a much lower profile than post-and-washer and interference-screw constructs. This is the first description of subcortical backup fixation in ACL reconstruction.
AB - Anterior cruciate ligament (ACL) injuries result in knee instability in a majority of patients. Repair and reconstruction techniques have continually evolved over the past several decades. ACL reconstruction outcomes are directly impacted by physical therapy with early range of motion, weightbearing, and progressive strengthening. Therefore, the fixation must be sufficient to withstand the tensile and shear stresses across the graft construct during the biological healing phase. Occasionally, the primary fixation device is not strong enough to withstand these stresses. In turn, supplementary fixation devices, which are important especially in cases of revision ACL reconstruction, are imperfect. They occasionally become symptomatic, requiring hardware removal. Posts and washers require bicortical fixation, with moderate-sized holes in the tibia. Biocomposite screws rely on friction in the bone–screw interface, making them susceptible to failure. Tensioning can be problematic with the use of a post-and-washer construct. Subcortical fixation, which has not previously been described as a backup fixation method, provides several advantages. It requires a smaller, unicortical hole and provides fixation with a much lower profile than post-and-washer and interference-screw constructs. This is the first description of subcortical backup fixation in ACL reconstruction.
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U2 - 10.1016/j.eats.2021.10.006
DO - 10.1016/j.eats.2021.10.006
M3 - Article
C2 - 35155109
AN - SCOPUS:85123726622
SN - 2212-6287
VL - 11
SP - e171-e176
JO - Arthroscopy Techniques
JF - Arthroscopy Techniques
IS - 2
ER -