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Logo of bmcmudisBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Musculoskeletal Disorders
 
BMC Musculoskelet Disord. 2012; 13: 115.
Published online Jun 27, 2012. doi:  10.1186/1471-2474-13-115
PMCID: PMC3492212
Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up
Wojciech Widuchowski,corresponding author1 Malgorzata Widuchowska,#2 Bogdan Ko czy,#1 Szymon Dragan,#3 Andrzej Czamara,#4 Wieslaw Tomaszewski,#4 and Jerzy Widuchowski#1
1District Hospital of Orthopedics and Trauma Surgery, Department of the Knee Surgery, Arthroscopy and Sports Traumatology, Piekary Slaskie, Poland
2Department of Internal Medicine and Rheumatology, Medical University of Silesia, Katowice, Poland
3Department and Clinic of Orthopaedic and Traumatologic Surgery, Faculty of Postgraduate Medical Training, Wrocław Medical University, Wrocław, Poland
4College of Physiotherapy in Wrocław, Wrocław, Poland
corresponding authorCorresponding author.
#Contributed equally.
Wojciech Widuchowski: sportmed/at/sportmed.com.pl; Malgorzata Widuchowska: mw/at/sportmed.com.pl; Bogdan Ko czy: sekretariat/at/urazowka.piekary.pl; Szymon Dragan: szymondragan/at/wp.pl; Andrzej Czamara: a.czamara/at/wsf.wroc.pl; Wieslaw Tomaszewski: w.tomaszewski/at/wp.pl; Jerzy Widuchowski: j.w/at/neostrada.pl
Received September 17, 2011; Accepted June 15, 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.
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