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Intraoperative details of the expandable implantation in a right knee. (A) Passage of the hamstring tendons through the eyelet of the femoral AperFix device. (B) Marking of the aperture depth indicator to ensure proper femoral fixation at joint line. (C) Arthroscopic picture just before the insertion of AperFix femoral implant. (D) Intraoperative picture showing the gradual retrieval of each tendon (whipstitched with different suture) while the assistant is holding the rest of them and (E) fixation at the tibial site using the AperFix sheath and screw tibial implant.
Source publication
Purpose
To compare anterior cruciate ligament (ACL) autograft reconstruction using fixed-looped suspensory versus expandable femoral fixation through the anteromedial portal.
Methods
After we performed prospective power analysis and obtained institutional review board, 70 patients with ACL rupture were block randomized to the expandable or suspens...
Contexts in source publication
Context 1
... size of the implant (diameter 9, 10, or 11) was determined by the graft diameter (7.5, 8-9, or 9-10 in respect). The prepared hamstring tendons were loaded to the separate eyelets of the implant, whipstitched with sutures of different color, and their suture ends were wrapped around the suture cleats of the femoral inserter handle in a fashion that resembles a "double-bundle ACL reconstruction through singe tunnel" (Fig 1A). The accessory medial portal was extended by 2 cm to allow the passage of the implant and a looped recovery suture was passed inside the joint and retrieved from the tibial tunnel while both its ends were secured with forceps. ...
Context 2
... accessory medial portal was extended by 2 cm to allow the passage of the implant and a looped recovery suture was passed inside the joint and retrieved from the tibial tunnel while both its ends were secured with forceps. Graft preparation was completed, after drawing a horizontal mark on the top of the tendon bundles at the inferior edge of the implant to serve as the aperture depth indicator (Fig 1B). The implant was inserted through the accessory medial portal towards the femoral socket with the knee in 120 of flexion and was impacted until the horizontal mark was flush with the femur ( Fig 1C). ...
Context 3
... preparation was completed, after drawing a horizontal mark on the top of the tendon bundles at the inferior edge of the implant to serve as the aperture depth indicator (Fig 1B). The implant was inserted through the accessory medial portal towards the femoral socket with the knee in 120 of flexion and was impacted until the horizontal mark was flush with the femur ( Fig 1C). Deployment of the screw was performed to compress the graft against the tunnel walls and the inserter handle from the implant was released with caution by pulling back on the implant release knob. ...
Context 4
... anchor's stability was verified by pulling the sutures from the medial portal. After completion of femoral fixation, we proceeded with the passage of the tendons through the knee joint; the sutures of both ends of the tendons were passed through the loop of the recovery suture and pulled down into the tibial tunnel, while holding the 4 tendons around the assistant's finger or using forceps, so that they did not pass all together at once ( Fig 1D). After passing all 4 sutures from the tibial tunnel one tendon at a time was gradually recovered, pulling the corresponding suture while holding the rest, until all 4 tendons finally were passed through the tibial tunnel. ...
Context 5
... performing 10 to 15 cycles of flexioneextension to calibrate the graft's tension, we proceeded with the tibial fixation (Fig 1E). The implant used in both groups was the AperFix II Tibial Implant with Driver system (Cayenne Medical, Inc.) using screws 1 mm larger than the diameter of the tibial tunnel. ...
Context 6
... implant used in both groups was the AperFix II Tibial Implant with Driver system (Cayenne Medical, Inc.) using screws 1 mm larger than the diameter of the tibial tunnel. The graft was fixed in 15 to 20 of flexion and an additional staple was used in all cases (Fig 1D). At the completion of the surgical procedure, the incision sites were infiltrated with 30 mL of 0.25% bupivacaine with epinephrine and a drainage was applied for 24 hours. ...
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Background
Anterior cruciate ligament (ACL) reconstruction is usually performed with autologous bone–patellar tendon–bone (PT) or hamstring tendon (HT) graft. There has been only 1 randomized clinical trial examining ACL reconstruction with these grafts specifically in soccer players, and more studies comparing these graft types within a homogenous...
Citations
... Tunnels diameters at 12 months post-op.14 ...
Human knee joint is a complex hinge joint which is relatively unstable compared to other joints of the body. The ligaments of the knee stabilize the joint during the different range of motion and are under continuous tension. This results in anterior cruciate ligament (ACL) being injured during unnatural movement of the joint particularly in sports. With the advent of arthroscopy and better understating of ligament injuries with the use of MRI, the ligament reconstruction procedures have increased. The Reconstructive procedures for the ACL impart use of an Autograft which is secured in the bony tunnels of femur and tibia using various methods. As with any fixation these materials are subjected to various biological and mechanical forces. Suspensory or aperture graft fixation are the two most commonly employed methods in recent times. Both these methods have different tensile strengths and failure rates. Various studies have been conducted to assess the outcomes of these methods to evolve the most suitable and fail-safe method of securing the ACL allograft in the bony tunnels.
Recurrent Patellar Dislocation (RPD) is a common knee sports injury, mainly affecting pediatric and adolescent populations, posing a significant challenge in orthopedic clinical practice. Although a variety of treatments have been reported, and many of them have shown good initial results, there is a lack of long-term follow-up results. Each treatment method has its own unique characteristics and limitations, and there is no standardized and unified treatment plan. This article provides a comprehensive review of current treatments for RPD. We believe that regardless of the surgical method used, patellar dislocation should not occur at 0°–90° of postoperative knee flexion and extension, and the range of motion should not be limited. Our ultimate goal is to restore patellar stability and improve lower limb alignment, thereby restoring knee function as much as possible. In addition, future treatment options for RPD are also discussed. In the future, there should be more in-depth research on the risk factors and pathogenesis that lead to recurrent patellar dislocation, as well as more randomized controlled trials focusing on different treatment methods. A comprehensive understanding of these is crucial for implementing preventive measures and developing targeted treatment strategies. The goal of this narrative review is to offer clinicians a deeper understanding of RPD treatment, enhance clinical decision-making skills, and encourage personalized and efficient management of RPD treatment.
Anterior cruciate ligament reconstruction aims to improve knee stability and range of motion. The AperFix system consists of polymer components, and fixed-loop fixation is an established endoscopic technique. Our aim in this study was to compare the long-term clinical and radiological results of AperFix and fixed-loop fixation and to prove that the long-term results of the AperFix fixation method are at least as good as those of the fixed loop device. This retrospective study included 109 patients who underwent primary anterior cruciate ligament reconstruction using single bundled hamstring tendon grafts. Patients under 16 years of age, patients with incomplete follow-up, bilateral or other ligament injuries, inflammatory arthropathy, previous knee surgery, or concurrent meniscal treatment were excluded. Participants were divided into 2 groups according to femoral fixation methods: AperFix fixation (group 1, n = 55) and fixed loop device fixation (group 2, n = 54). All operations were performed by senior surgeons under general or spinal anesthesia. Postoperative rehabilitation started on day 1 and allowed patients to resume normal activities at 6 months. Outcomes were evaluated during follow-up, including knee range of motion, clinical scores [Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee] and radiographic measurements of femoral tunnel width and length. Measurements were performed by 2 orthopedic surgeons to ensure reliability. This study evaluated 109 patients (55 in group 1, 54 in group 2) and found no statistically significant differences in demographic variables such as age, sex, body mass index, follow-up duration, or side distribution. Clinical outcomes, including anterior drawer test, Lachman test results, knee flexion-extension degrees, and Lysholm, Cincinnati, Tegner, and International Knee Documentation Committee scores, were similar between the groups ( P > .05). Complications occurred in 8 cases (rerupture, infection, and deep vein thrombosis), with no significant correlation to the fixation method used ( P = .506). Radiographic analysis revealed no significant differences in femoral tunnel width or length between the groups ( P > .05). In our current study, no meaningful disparity was found between the AperFix and fixed loop device methods in terms of long-term clinical outcomes. As there are no long-term studies on the results of AperFix fixation in the literature, more studies on this subject are needed.
Introduction
Arthroscopic reconstruction of the anterior cruciate ligament (ACL) using an autogenous quadrupled hamstring graft has been the standard of surgical treatment in ACL-deficient knees, particularly in young athletic individuals. There are two widely used methods for graft fixation, namely aperture fixation and suspensory fixation.
Material and Methods
This prospective randomized single blinded clinical study was carried out with enrollment of 70 patients (35 patients in each group) who underwent simple block randomization process. Group 1 has 35 patients treated with suspensory fixation technique and Group 2 has 35 patients treated with aperture fixation technique.
Result
It is observed that there is a statistically significant difference between the mode of injury and diagnosis in suspensory method. In the majority of the cases, patients who got injury by road traffic accidents (RTA) was diagnosis by 15 (51.7%) ACL Grade 3 and 3 (60%) ACL Grade 4. It is observed that there is a statistically significant difference between the mode of injury and diagnosis in screw fixation. In the majority of the cases, patients who got injury by RTA was diagnosis by 1 (100%) ACL Grade 2, 15 (51.7%) ACL Grade 3, and 3 (60%) ACL Grade 4.
Conclusion
Arthroscopy-assisted ACL reconstruction with quadrupled semitendinosus tendon autograft using endobutton and bioabsorbable interference screw is an excellent treatment option for ACL-deficient knees.
