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Open Access Research article

Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up

Wojciech Widuchowski1*, Malgorzata Widuchowska2, Bogdan Ko czy1, Szymon Dragan3, Andrzej Czamara4, Wieslaw Tomaszewski4 and Jerzy Widuchowski1

Author Affiliations

1 District Hospital of Orthopedics and Trauma Surgery, Department of the Knee Surgery, Arthroscopy and Sports Traumatology, Piekary Slaskie, Poland

2 Department of Internal Medicine and Rheumatology, Medical University of Silesia, Katowice, Poland

3 Department and Clinic of Orthopaedic and Traumatologic Surgery, Faculty of Postgraduate Medical Training, Wrocław Medical University, Wrocław, Poland

4 College of Physiotherapy in Wrocław, Wrocław, Poland

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BMC Musculoskeletal Disorders 2012, 13:115  doi:10.1186/1471-2474-13-115

Published: 27 June 2012

Abstract

Background

If anterior cruciate ligament (ACL) reconstruction is to be performed, decision regarding graft choice and its fixation remains one of the most controversial. Multiple techniques for ACL reconstruction are available. To avoid disadvantages related to fixation devices, a hardware-free, press-fit ACL reconstruction technique was developed.

The aim of this study was to evaluate clinical outcome and osteoarthritis progression in long term after ACL reconstruction with central third patellar-tendon autograft fixed to femur by press-fit technique.

Methods

Fifty two patients met inclusion/excusion criteria for this study. The patients were assessed preoperatively and at 15 years after surgery with International Knee Documentation Committee Knee Ligament Evaluation Form, Lysholm knee score, Tegner activity scale and radiographs.

Results

Good overall clinical outcomes and self-reported assessments were documented, and remained good at 15 years. The mean Lysholm and Tegner scores improved from 59.7 ± 18.5 and 4.2 ± 1.0 preoperatively to 86.4 ± 5.6 (p = 0.004) and 6.9 ± 1.4 (p = 0.005) respectively at follow-up. The IKDC subjective score improved from 60.1 ± 9.2 to 80.2 ± 8.1 (p = 0.003).

According to IKDC objective score, 75% of patients had normal or nearly normal knee joints at follow-up. Grade 0 or 1 results were seen in 85% of patients on laxity testing. Degenerative changes were found in 67% of patients. There was no correlation between arthritic changes and stability of knee and subjective evaluation (p > 0.05).

Conclusions

ACL reconstruction with patellar tendon autograft fixed to femur with press-fit technique allows to achieve good self-reported assessments and clinical ligament evaluation up to 15 years. Advantages of the bone-patellar-tendon-bone (BPTB) press-fit fixation include unlimited bone-to-bone healing, cost effectiveness, avoidance of disadvantages associated with hardware, and ease for revision surgery. BPTB femoral press-fit fixation technique can be safely applied in clinical practice and enables patients to return to preinjury activities including high-risk sports.