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Koukoulias NE, Germanou E, Koukoulias D, Vasiliadis AV, Dimitriadis T. Intra-articular migration of tibial suture button in pediatric full epiphyseal anterior cruciate ligament reconstruction. A case report. J ISAKOS 2024; 9:100303. [PMID: 39127226 DOI: 10.1016/j.jisako.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/27/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024]
Abstract
We report a case of a 12-years-old boy that underwent anterior cruciate ligament (ACL) reconstruction and lateral meniscus repair. The all-epiphyseal, all-inside technique, with quadriceps tendon autograft and adjustable suspensory button fixation was utilized due to the open physes. Intraoperative fluoroscopy confirmed optimal position of the buttons, while arthroscopic evaluation of the graft showed proper tension, with full range of motion and knee stability. Nevertheless, routine radiographic evaluation of the knee, 6 h postoperatively, revealed tibial button migration through the tunnel into the knee joint, while the knee was unstable in clinical examination. The graft was removed and reloaded with extended buttons. The femoral socket was retained in the revision surgery while a new tibial socket was drilled with the transphyseal technique (all-inside technique). The postoperative course was uneventful. The patient returned to unrestricted activities at twelve months after revision surgery and remains fully active two years postoperatively. This is the first case of tibial button migration reported in the literature, with immediate migration after surgery, intra-articular position of the button and negative impact on graft tension. Failure to recognize and treat this detrimental complication could be catastrophic for the knee. The technique of the surgical treatment is also described. Surgeons should be aware of this rare complication, that could adversely affect the clinical outcome.
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Affiliation(s)
- Nikolaos E Koukoulias
- Sports Trauma and Orthopaedic Department, St. Luke's Hospital, Thessaloniki, Greece.
| | - Evangelia Germanou
- Aristotle University of Thessaloniki, Department of Physical Education and Sport Science, Thessaloniki, Greece
| | - Dimitris Koukoulias
- International Hellenic University, Department of Physiotherapy, Thessaloniki, Greece
| | - Angelo V Vasiliadis
- Sports Trauma and Orthopaedic Department, St. Luke's Hospital, Thessaloniki, Greece
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Tsujii A, Takami H, Sato S, Mae T, Ohori T, Tanaka H, Okada S, Nakata K. Deep Infection After Anterior Cruciate Ligament Reconstruction Diagnosed by Intratunnel Suspensory Fixation Device Migration: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00003. [PMID: 37797166 DOI: 10.2106/jbjs.cc.23.00312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
CASE A 43-year-old woman sustained an anterior cruciate ligament injury while kickboxing and underwent anterior cruciate ligament reconstruction with hamstring autograft with suspensory fixation. Lateral thigh wound was superficially infected at 2 weeks postoperatively with resolution of signs and symptoms after debridement. Three months later, posterolateral knee pain developed and radiographs revealed intratunnel migration of the device. That observation with abnormal magnetic resonance imaging and serology results led to the diagnosis of deep infection. Immediate device removal and debridement were performed. Consequently, the grafts were preserved, and the patient could perform kickboxing 2 years thereafter. CONCLUSIONS Intratunnel migration of suspensory fixation devices can support a diagnosis of infection.
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Affiliation(s)
- Akira Tsujii
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Haruna Takami
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Seira Sato
- Department of Sports Medical Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Sports Medical Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ken Nakata
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, Osaka, Japan
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Guy S, Carrozzo A, Ferreira A, Vieira TD, Freychet B, Thaunat M, Sonnery-Cottet B. Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:2251-2258. [PMID: 34665299 PMCID: PMC8523932 DOI: 10.1007/s00167-021-06758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to determine whether direct arthroscopic control of femoral buttons can prevent improper deployment and soft tissue interposition in anterior cruciate ligament (ACL) reconstruction. METHODS A retrospective analysis of prospectively collected data from the SANTI study group database was performed. All patients who underwent ACL reconstruction using suspensive femoral fixation between 01/01/2017 and 31/12/2019 were included. Patient assessment included demographics, sports metrics, reoperations performed and femoral button-related specific complications such as iliotibial band (ITB) irritation and/or septic arthritis. Proper deployment of the button and soft tissue interposition were assessed on postoperative radiographs. RESULTS A total of 307 patients underwent ACL reconstruction using adjustable femoral button fixation and were analyzed after a mean follow-up of 35.2 ± 11.0 months (14.3-50.2). The mean age was 39.5 ± 10.9-years old (range 13.3-70.6). Postoperative radiographs showed a correctly deployed femoral button without soft tissue interposition for all patients. No septic arthritis was reported. Nine patients (2.9%) suffered from lateral pain related to ITB irritation due to the button. Five of them had their symptoms resolve during rehabilitation. Ultrasound-guided corticosteroid infiltration was necessary for four patients after an average delay of 14.5 ± 4.8 months (11.7-21.7). Three patients were then symptom-free, but one required surgical removal of the implant 27.5 months after the surgery. Regarding unrelated femoral button complications, 15 patients (4.9%) underwent secondary arthroscopic procedures, including meniscectomy (1.6%), surgery for cyclops syndrome (2.6%) and revision ACLR (0.7%). CONCLUSION Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition without specific complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sylvain Guy
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Alessandro Carrozzo
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Alexandre Ferreira
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Thais Dutra Vieira
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France.
| | - Benjamin Freychet
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Mathieu Thaunat
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| | - Bertrand Sonnery-Cottet
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
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4
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Yassa R, Adam JR, Charalambous CP. Complications following Suture Button Use for Femoral Graft Fixation in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Systematic Review. J Knee Surg 2021; 34:755-763. [PMID: 31905415 DOI: 10.1055/s-0039-3400753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Understanding any potential complications that may occur in relation to the use of a suture button for femoral graft fixation in arthroscopic anterior cruciate ligament reconstruction can help raise awareness among surgeons and improve safety when using such implants. This is a systematic review of suture button related complications. A literature search was conducted using the PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases from their year of inception until January 3, 2019. We included studies reporting on suture button related complications in their outcomes of femoral graft suture button fixation in anterior cruciate ligament reconstruction. Our search identified 479 articles, of which 19 met our inclusion criteria. Suture button misplacement (initial or subsequent migration) was the most commonly reported complication. Although, in most cases, button misplacement is minimal and does not adversely affect clinical outcomes, in some cases it may lead to graft failure or local soft tissue irritation and require further surgery. Intraoperative screening or arthroscopic evaluation of the deployed suture button may reduce this complication.
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Affiliation(s)
- R Yassa
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - J R Adam
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - C P Charalambous
- Department of Orthopaedics, Blackpool Victoria Hospital, Blackpool, United Kingdom.,School of Medicine, University of Central Lancashire, Preston, United Kingdom
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Matassi F, Sani G, Innocenti M, Giabbani N, Civinini R. Arthroscopic confirmation of femoral button deployment avoids post-operative X-ray in ACL reconstruction. PHYSICIAN SPORTSMED 2021; 49:171-175. [PMID: 32669026 DOI: 10.1080/00913847.2020.1796469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Anterior cruciate ligament reconstruction (ACLR) with cortical fixation adjustable-loop devices are associated with high potential risk of button malpositioning or interposition of the soft tissue between lateral femoral cortex and the button. Surgeons usually use X-rays to check and avoid button malposition and soft tissue interposition. Arthroscopic visualization of button position through the lateral gutter has been described. With this technique, it is possible for identification and correction of femoral button malalignment in the setting of soft tissue interposition and it could avoid the use of post-operative X-ray. METHODS A total of 193 ACLR were included and patients were randomized into two groups. The first series (Group A) of 112 patients who sustained an ACLR with post-operative X-ray to assess the position of the femoral button and the second series (Group B) of 81 patients who sustained an ACLR with an arthroscopic exploration of the button followed by post-operative X-ray. RESULTS On the post-operative radiographs, tissue interposition between the button and femoral cortex was found in nine cases of 112 in Group A (8%) and in zero case of 81 in Group B (0%). In six cases (7,4%) in Group B, there was a soft tissue interposition between the button and femoral cortex as visualized by arthroscopic confirmation and before post-operative X-ray; in all these cases, the soft tissue was removed, and the button was in contact with the bone in all X-ray made in the Group B. CONCLUSIONS This technique allows for identification and correction of femoral button malalignment in the setting of soft tissue interposition and reduces the use of post-operative X-ray.
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Affiliation(s)
- Fabrizio Matassi
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Giacomo Sani
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Matteo Innocenti
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Niccolò Giabbani
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
| | - Roberto Civinini
- Orthopaedic Clinic, University of Florence, AOU Careggi, Florence, Italy
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O'Brien DF, Fones L, Stoj V, Edgar C, Coyner K, Arciero RA. Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction. Orthop J Sports Med 2021; 9:2325967120974349. [PMID: 33521157 PMCID: PMC7817951 DOI: 10.1177/2325967120974349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/14/2020] [Indexed: 11/15/2022] Open
Abstract
Background Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. Purpose To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. Study Design Case series; Level of evidence, 4. Methods All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship-trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. Results A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. Conclusion Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.
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Affiliation(s)
- Daniel F O'Brien
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Lilah Fones
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Victoria Stoj
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Cory Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Katherine Coyner
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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Gürpınar T, Polat B, Eren M, Çarkçı E, Özyalvaç ON, Erdoğan S. The effect of soft tissue interposition of the Endobutton on clinical results and on its postoperative migration after single-bundle anterior cruciate ligament reconstruction. Knee 2020; 27:1980-1987. [PMID: 33248352 DOI: 10.1016/j.knee.2020.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 08/29/2020] [Accepted: 10/17/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to investigate the possible consequences of soft tissue interposition of Endobutton on clinical outcomes and reoperation rates after anterior cruciate ligament reconstruction. METHODS We measured the distance between the centre of the Endobutton and the lateral femoral cortex on the postoperative first day anteroposterior X-rays of the 156 knees that underwent anterior cruciate ligament reconstruction. Those with a distance less than 1 mm were regarded as Group 1 (118 patients), the ones between 1 mm and 2 mm were regarded as Group 2 (30 patients) and the ones more than 2 mm were regarded as Group 3 (8 patients). The movement of the Endobutton of more than 1 mm along the femoral tunnel axis on anteroposterior X-rays or its rotation by more than 5° on lateral X-rays during follow-up were considered migration. Clinical assessment scores (Lysholm, Tegner Activity Scale), clinical examination tests, and rates of Endobutton migration in the groups were analysed. RESULTS Eleven Endobuttons (9.3%) in Group 1, 26 Endobuttons (86.7%) in Group 2 and all of the 8 Endobuttons (100%) in Group 3 were observed to have migrated. Clinical results and examination tests showed no significant difference between Groups 1 and 2, whereas a significant difference was detected in Group 3 compared to Groups 1 and 2 (p < 0.05). CONCLUSION Soft tissue interposition is a major cause of Endobutton migration, and an interposition over 2 mm between the Endobutton and the lateral femoral cortex can negatively affect the outcomes after an anterior cruciate ligament surgery.
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Affiliation(s)
- Tahsin Gürpınar
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Barış Polat
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Kyrenia, Kyrenia, Cyprus.
| | - Murat Eren
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Engin Çarkçı
- Department of Orthopaedics and Traumatology, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Osman Nuri Özyalvaç
- Department of Orthopaedics and Traumatology, Baltalimanı Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
| | - Sinan Erdoğan
- Department of Orthopaedics and Traumatology, Baltalimanı Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
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Buyukkuscu MO, Misir A, Cetinkaya E, Ezici A, Ozcafer R, Gursu SS. The interposition of soft tissue between the cortical button and femoral lateral cortex significantly increases button migration but does not negatively affect knee stability and clinical outcome. Knee 2020; 27:891-898. [PMID: 32201042 DOI: 10.1016/j.knee.2020.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/01/2020] [Accepted: 02/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In clinical practice, soft tissue interposition may occur during femoral graft fixation. Soft tissue interposition between the lateral femoral cortex and the cortical button may affect graft tension and related longitudinal graft motion in the tunnel. We aimed to investigate the effect of soft tissue interposition on button migration and clinical outcomes in anatomical single-bundle anterior cruciate ligament reconstruction. METHODS Eighty-four patients aged 18-40 years, who underwent anatomical single-bundle anterior cruciate ligament reconstruction with quadruple hamstring autograft were included. Patients were divided into two groups as Group 1 (n = 32) with soft tissue interposition between the cortical button and cortex, and Group 2 (n = 52) without soft tissue interposition. At the one-year follow-up visit, the anteroposterior knee stability of the patients was evaluated using the Lachman test and KT-2000 arthrometer, and rotational stability was assessed with the pivot shift test. The Lysholm knee score was used to evaluate the functional outcome of the patients. Relationship between tissue interposition and clinical outcome, and button migration was examined. RESULTS Button migration was observed in 12 patients in Group 1 (37.5%) and two patients (3.84%) in Group 2 (p < 0.001). However, no significant difference was observed between patients with and without tissue interposition or those with and without button migration regarding knee stability parameters and clinical outcome (p < 0.05). CONCLUSIONS Postoperative tissue interposition is found to be associated with cortical button migration during the follow-up. However, it does not affect the clinical outcome.
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Affiliation(s)
- Mehmet Ozbey Buyukkuscu
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey.
| | - Abdulhamit Misir
- Department of Orthopaedics and Traumatology, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Engin Cetinkaya
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Atakan Ezici
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Rasit Ozcafer
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
| | - Sukru Sarper Gursu
- Department of Orthopaedics and Traumatology, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Istanbul, Turkey
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Late Migration of an Adjustable-Loop Cortical Suspension Device in Anterior Cruciate Ligament Reconstruction. Case Rep Orthop 2019; 2019:1061385. [PMID: 31531256 PMCID: PMC6721472 DOI: 10.1155/2019/1061385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/08/2019] [Accepted: 06/27/2019] [Indexed: 01/13/2023] Open
Abstract
A unique case of late migration of an adjustable-loop femoral fixation button utilized during anterior cruciate ligament (ACL) reconstruction is presented. Imaging and physical examinations during the patient's postoperative course were unremarkable for graft or hardware failure. Two years postoperatively, symptomatic hardware migration occurred requiring arthroscopic removal. To our knowledge, this is the first reported case of late migration of an adjustable-loop femoral fixation button in ACL reconstruction. This case highlights that late loosening and migration of adjustable-loop femoral fixation devices in ACL reconstruction can occur despite demonstrated postoperative radiographic and clinical stability. Surgeons utilizing this fixation device should be aware of this potential complication to avoid delayed recognition and patient morbidity.
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10
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Palazzolo A, Rosso F, Bonasia DE, Saccia F, Rossi R. Uncommon Complications after Anterior Cruciate Ligament Reconstruction. JOINTS 2018; 6:188-203. [PMID: 30582108 PMCID: PMC6301892 DOI: 10.1055/s-0038-1675799] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 10/07/2018] [Indexed: 02/06/2023]
Abstract
Anterior cruciate ligament reconstruction (ACL-R) is a common surgical procedure, with good outcome in 75 to 97% of the cases. However, different complications have been described including infection, hemarthrosis, deep vein thrombosis (DVT), and pulmonary embolism (PE) with a rate ranging from 1 to 15%. There are few case reports in the literature describing rare complications after ACL-R and they can be divided into: (1) complications related to the fixation device (rupture, migration); (2) fractures (tibial or femoral side); (3) infections due to uncommon bacteria, mycobacterium, and mycosis; (4) rare vascular injuries; (5) nerve injuries; and (6) other rare complications. In case of fixation device rupture or migration, device removal can be easy but the diagnosis may be challenging. Patellar fracture after ACL-R may be related to harvesting and it is not uncommon. Conversely, femoral or tibial fractures are most frequently due to bone weakness related to bone tunnels. Some rare infections related to uncommon bacteria or mycosis are also described with potentially devastating joint damage. Popliteal artery injuries are uncommon in ACL-R but minor vessels damages are described with possible severe consequences for patients. Injuries to the infrapatellar branch of the saphenous nerve are not uncommon in ACL-R. However, there are few case reports also describing injuries to the saphenous nerve, the common peroneal nerve and the sciatic nerve. The aim of this paper is to review the literature describing uncommon complications after ACL-R, giving some more information about diagnosis and treatment.
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Affiliation(s)
- Anna Palazzolo
- Department of Orthopedics and Traumatology, Università degli studi di Torino, Turin, Italy
| | - Federica Rosso
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano, Turin, Italy
| | | | - Francesco Saccia
- Orthopaedics and Traumatology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Roberto Rossi
- Department of Orthopaedics and Traumatology, AO Ordine Mauriziano, Turin, Italy
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Ouanezar H, Blakeney WG, Fernandes LR, Borade A, Latrobe C, Temponi EF, Sonnery-Cottet B. Clinical Outcomes of Single Anteromedial Bundle Biologic Augmentation Technique for Anterior Cruciate Ligament Reconstruction With Consideration of Tibial Remnant Size. Arthroscopy 2018; 34:714-722. [PMID: 29198590 DOI: 10.1016/j.arthro.2017.08.309] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to evaluate the functional outcomes, knee stability, complications, and reoperations associated with anatomic anterior cruciate ligament (ACL) reconstruction using the single anteromedial bundle biological augmentation (SAMBBA) technique in a consecutive series of 128 patients with a minimum follow-up of 24 months. A secondary aim was to compare larger preserved ACL remnants with smaller preserved remnants. METHODS Patients who underwent primary anatomic ACL reconstruction using the SAMBBA technique from July 2013 to October 2014 were analyzed. Exclusion criteria were (1) age <16 years, (2) revision cases, (3) multiple ligament injuries, (4) chondral lesions greater than grade 2 according to the Outerbridge classification, (5) additional injuries to the collateral ligaments greater than grade 2, or (6) a history of a contralateral ACL injury. Clinical assessment including evaluation of side-to-side difference and functional outcome measures with the International Knee Documentation Committee (IKDC) subjective score and the Tegner Activity Scale were used to evaluate outcomes before surgery and at the last follow-up. Any subsequent surgical procedures were systematically recorded during the study period. The patients were also divided in 2 groups according to their ACL remnant size, ≥50% or <50%, and compared. RESULTS Of the 135 patients who underwent primary SAMBBA technique, 128 patients returned to final follow-up, with a mean follow-up of 31.7 months (range, 24-44.3). At last follow-up, the IKDC score significantly improved from 54.1 ± 15.1 to 92.5 ± 11.4 (P < .001); the Tegner activity score (6.4 ± 1.2) was similar (P = .3) to the preinjury score (6.5 ± 1.2). Side-to-side laxity significantly improved from 6.7 ± 1.2 mm to 0.7 ± 1 mm (P < .001). Twenty-four subsequent surgeries (18.7%) were performed including 10 meniscal procedures, 7 ACL revisions, 5 arthroscopies for cyclops lesions, one microfracture, and one manipulation under anaesthesia. The side-to-side laxity (P = .30) and rates of reoperation (P = .65), graft failure (P = .45), and cyclops lesions (P = .67) were not significantly different between ≥50% or <50% ACL remnant groups. CONCLUSIONS The results of this study demonstrate that primary anatomic ACL reconstruction using the SAMBBA technique significantly improved clinical and functional outcomes between baseline and follow-up at a minimum of 24 months. A low rate of complications was observed with this technique. No significant differences between large and moderate size ACL remnants were detected for all outcome measures. LEVEL OF EVIDENCE Level IV case series with subgroup analysis.
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Affiliation(s)
- Hervé Ouanezar
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - William G Blakeney
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Levi Reina Fernandes
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Amrut Borade
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Charles Latrobe
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | | | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France.
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Ho SW, Lee KT. A Rare Case of Intra-Articular Displacement of EndoButton Following Anterior Cruciate Ligament Reconstruction. Clin Orthop Surg 2017; 9:534-536. [PMID: 29201308 PMCID: PMC5705314 DOI: 10.4055/cios.2017.9.4.534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/11/2016] [Indexed: 11/17/2022] Open
Abstract
The EndoButton is a commonly used device for femoral fixation of anterior cruciate ligament grafts. Complications from its usage remain rare. Incorrect femoral tunnel placement may increase the risk of intra-articular displacement of the EndoButton. We present a case of anterior femoral tunnel placement resulting in intra-articular displacement of the EndoButton after failure. A 24-year-old man presented to us after failure of anterior cruciate ligament reconstruction performed 3 years prior. Radiographs revealed an intra-articular displacement of the EndoButton. Intraoperatively, it was noted that the femoral tunnel exit was within the suprapatellar pouch, with the displaced EndoButton lodged between the posterior aspect of the lateral tibial plateau and the capsule. Intra-articular displacement of the EndoButton is a rare complication and has only been reported twice in the literature. Anterior placement of the femoral tunnel may predispose patients to this complication and it is recommended to check the EndoButton position intraoperatively to avoid such a complication, especially for the unexperienced surgeon.
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Affiliation(s)
- Sean Wl Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Keng Thiam Lee
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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Ohnishi Y, Chang A, Utsunomiya H, Suzuki H, Nakamura E, Sakai A, Uchida S. Arthroscopic Technique to Reduce Suture Button Migration During Anterior Cruciate Ligament Reconstruction Procedure. Arthrosc Tech 2017; 6:e1927-e1931. [PMID: 29416980 PMCID: PMC5797844 DOI: 10.1016/j.eats.2017.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/11/2017] [Indexed: 02/03/2023] Open
Abstract
Suture button-based femoral cortical suspension constructs of anterior cruciate ligament grafts can facilitate a fast and secure fixation. However, there are several case reports showing button malpositioning resulting from the inability to visualize the "flipped" button. Many current surgical techniques do not allow direct visualization of EndoButtons (Smith & Nephew, Andover, MA) in their final position, making it difficult to ensure that both buttons are fully flipped and that there is no soft-tissue interposition between the button and femur. We describe an arthroscopic technique for making femoral tunnels through the outside-in method that reduces the migration of the EndoButton through a lateral femoral portal. This technique may assist surgeons in understanding how to deal with and potentially avoid EndoButton migration during anterior cruciate ligament reconstruction.
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Affiliation(s)
- Yasuo Ohnishi
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Angela Chang
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Hitoshi Suzuki
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Eiichiro Nakamura
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan,Address correspondence to Soshi Uchida, M.D., Ph.D., Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, 1-17-1 Hamamachi, Wakamatsu, Kitakyushu, Fukuoka 808-0024, Japan.Department of Orthopaedic SurgeryWakamatsu Hospital for the University of Occupational and Environmental Health1-17-1 HamamachiWakamatsuKitakyushuFukuoka808-0024Japan
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Kang SG, Lee YS. Arthroscopic Control for Safe and Secure Seating of Suspensory Devices for Femoral Fixation in Anterior Cruciate Ligament Reconstruction Using Three Different Techniques. Knee Surg Relat Res 2017; 29:33-38. [PMID: 28231646 PMCID: PMC5336367 DOI: 10.5792/ksrr.16.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 10/19/2016] [Accepted: 11/07/2016] [Indexed: 02/06/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the efficacy of our technique that allows direct visualization of seating of suspensory devices in anterior cruciate ligament (ACL) reconstruction. Materials and Methods Three different suspensory devices (TightRope RT, RetroButton, and EndoButton) were used in ACL reconstruction using 3 different techniques (outside-in, anteromedial [AM] portal, and transtibial techniques). Positioning of a guiding material and seating pattern of the suspensory devices were evaluated according to the surgical technique and suspensory device used. Results On the transtibial technique, 21 of total 26 cases (81%) of single bundle reconstructions and 22 of total 22 cases (100%) of double bundle reconstructions required superolateral capsulotomy where buttons were found in 21 of total 21 cases (100%) and 17 of 22 cases (77%), respectively. On the AM portal technique, all patients required capsulotomy and the button was found in only 18 of total 32 cases (56%) even after capsulotomy. On the outside-in technique, all patients required capsulotomy and the button was found in 86 of total 86 cases (100%). Conclusions Our technique for direct visualization of seating of the suspensory devices was more effective in outside-in and single bundle transtibial ACL reconstruction. However, it was less effective in double bundle transtibial and AM portal ACL reconstructions.
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Affiliation(s)
- Seo Goo Kang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Schemmann D, Rudolph J, Haas H, Müller-Stromberg J. Akzidentelle Quadrizepstenodese durch arthroskopische Kreuzbandplastik. ARTHROSKOPIE 2016. [DOI: 10.1007/s00142-016-0094-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Harato K, Niki Y, Toyoda T, Kamata Y, Masumoto K, Otani T, Suda Y. Self-flip Technique of the TightRope RT Button for Soft-Tissue Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2016; 5:e391-5. [PMID: 27462539 PMCID: PMC4948205 DOI: 10.1016/j.eats.2016.01.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/15/2016] [Indexed: 02/03/2023] Open
Abstract
The TightRope RT (Arthrex, Naples, FL) is a suspensory device for anterior cruciate ligament reconstruction. However, there is a potential risk of the button being pulled too far off the lateral femoral cortex into the soft tissue because the adjustable loop is long. The purpose of this article is to present an easy and safe technique for self-flip. As to the preparation of the graft, we draw the first line in the loop of the TightRope RT at the same length as the femoral tunnel, and we draw the second line 7 mm longer than the length of the femoral tunnel as a self-flip line. Concerning passing of the graft, the side sutures are pulled from the lateral side. We stop pulling the sutures just at the self-flip line by holding the graft at the tibial end. The side suture is inclined to the medial side with strong pulling of the suture at full extension of the knee. Then the surgeon pulls the tibial end of the graft to feel a secure positioning of the button on the lateral femoral cortex. Although it has limitations, the present technique is easy and certainly helps surgeons achieve appropriate positioning of the button.
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Affiliation(s)
- Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan,Address correspondence to Kengo Harato, M.D., Ph.D., Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.Department of Orthopedic SurgeryKeio University School of Medicine35 ShinanomachiShinjukuTokyo160-8582Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | - Yusaku Kamata
- Department of Orthopedic Surgery, Ashikaga Red Cross Hospital, Tochigi, Japan
| | | | - Toshiro Otani
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan
| | - Yasunori Suda
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Taketomi S, Inui H, Nakamura K, Yamagami R, Tahara K, Sanada T, Masuda H, Tanaka S, Nakagawa T. Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft. JOINTS 2016; 3:102-8. [PMID: 26889465 DOI: 10.11138/jts/2015.3.3.102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft. METHODS thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D CT. The clinical outcome was also assessed and correlated with the imaging outcomes. RESULTS the bone plug was integrated onto the femoral socket in all cases. The incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. No significant association was observed between the imaging outcomes. The postoperative mean Lysholm score was 97.1 ± 5.0 points. The postoperative side-to-side difference, evaluated using a KT-2000 arthrometer, averaged 0.5 ± 1.3 mm. There were no complications associated with EB use. Imaging outcomes did not affect the postoperative KT side-to-side difference. CONCLUSIONS the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPTB autograft. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Shuji Taketomi
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Kensuke Nakamura
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Keitaro Tahara
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Takaki Sanada
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | | | - Sakae Tanaka
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
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Akaoka Y, Tensho K, Shimodaira H, Aoki T, Takanashi S, Kato H, Saito N. Early Postoperative Intratunnel Migration of an EndoButton After Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Case Report. JBJS Case Connect 2014; 4:e111. [PMID: 29252779 DOI: 10.2106/jbjs.cc.n.00086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
CASE We report a rare case of early postoperative migration of an EndoButton following anatomic double-bundle anterior cruciate ligament reconstruction with use of the EndoButton for femoral fixation. Although secure fixation of the EndoButton was confirmed during the operation, one-week postoperative radiographs revealed an intratunnel displacement of the posterolateral EndoButton. We performed a reoperation and refixed the EndoButton to the surface of the femoral cortex; we also hooked and tied both ends of the sutures to make a knot in order to prevent remigration. CONCLUSION Orthopaedic surgeons should be aware that EndoButton displacement and migration could arise at an early postoperative stage.
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Affiliation(s)
- Yusuke Akaoka
- Departments of Orthopedic Surgery (Y.A., K.T., H.S., T.A., S.T., and H.K.) and Applied Physical Therapy (N.S.), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan. . . . . . .
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Uozumi Y, Nagamune K, Nakano N, Nagai K, Nishizawa Y, Hoshino Y, Matsushita T, Kuroda R, Kurosaka M. A Three-Dimensional Evaluation of EndoButton Displacement Direction After Anterior Cruciate Ligament Reconstruction in CT Image Using Tunnel Axis. JOURNAL OF ADVANCED COMPUTATIONAL INTELLIGENCE AND INTELLIGENT INFORMATICS 2014. [DOI: 10.20965/jaciii.2014.p0830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The goal of this study was to propose a threedimensional evaluation of the EndoButton displacement direction after anterior cruciate ligament reconstruction in the multidetector-row computed tomography (MDCT) image by using the tunnel axis. The proposed method was applied experimentally to six subjects. The result of the simulated experiment revealed that the proposed method could analyze EndoButton displacement direction satisfactorily because the error was less than that of the MDCT image resolution. The clinical experiment results revealed displacement relative to the tunnel between time-zero and the followup point. We conclude that the proposed method can quantitatively evaluate the EndoButton displacement direction from the raw MDCT image after anterior cruciate ligament reconstruction; further, our findings suggest that the EndoButton was displaced relative to the tunnel between time-zero and the follow-up point.
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Sonnery-Cottet B, Rezende FC, Martins Neto A, Fayard JM, Thaunat M, Kader DF. Arthroscopically confirmed femoral button deployment. Arthrosc Tech 2014; 3:e309-12. [PMID: 25126492 PMCID: PMC4130137 DOI: 10.1016/j.eats.2014.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/08/2014] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means "one size fits all," thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
- Address correspondence to Bertrand Sonnery-Cottet, M.D., Centre Orthopédique Santy, 24 Avenue Paul Santy, F-69008, Lyon, France.
| | | | | | - Jean M. Fayard
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Lyon, France
| | - Deiary F. Kader
- City Campus East, Northumbria University, Newcastle upon Tyne, England
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Uchida R, Mae T, Matsumoto N, Kuroda S, Toritsuka Y, Shino K. The effect of cortical button location on its post-operative migration in anatomical double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22:1047-54. [PMID: 23462955 DOI: 10.1007/s00167-013-2458-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 02/20/2013] [Indexed: 01/26/2023]
Abstract
PURPOSE To investigate the effect of EndoButton (Smith & Nephew Endoscopy, Andover, MA, USA) location on post-operative migration in anterior cruciate ligament (ACL) reconstruction. METHODS Seventy-seven patients underwent anatomical double-bundle ACL reconstruction using EndoButtons. Comparing patient radiographs immediately post-operatively with those at 1 year, migration was defined when EndoButtons moved more than 1 mm or rotated over 5°. Initial location of EndoButtons was evaluated on radiographs immediately post-operatively. We measured distances from the EndoButton to the posterior and distal edge of the femur (D1, D2) on lateral radiographs and distances from the EndoButton to the lateral and distal edge of the femur (D3, D4) on anteroposterior radiographs. The relationship between supracondylar line and the ratio of migration was also investigated. RESULTS D1 in the migrated group were significantly lower than those in the non-migrated group (11.8 ± 12.7 vs. 16.0 ± 10.2 mm). D2, D3 and D4 were not of significant difference in the two groups. The ratio of migration in the area posterior to the supracondylar line was significantly higher than that in the anterior area (54.3 vs. 15.1%). CONCLUSION EndoButtons, which was located distally and posteriorly, especially in the area posterior to the lateral supracondylar line, migrated more frequently, although migration of the button had no effect on the clinical parameters evaluated in this study. CLINICAL RELEVANCE It is preferable to settle EndoButton anteriorly to the lateral supracondylar line in order to avoid its migration for the graft tension due to our findings about the relationship between initial location of EndoButton and the rate of migration. LEVEL OF EVIDENCE Prognostic case series, Level IV.
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Affiliation(s)
- Ryohei Uchida
- Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-0064, Japan
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Taketomi S, Inui H, Hirota J, Nakamura K, Sanada T, Masuda H, Tanaka S, Nakagawa T. Iliotibial band irritation caused by the EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction: report of two cases. Knee 2013; 20:291-4. [PMID: 23714387 DOI: 10.1016/j.knee.2013.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/30/2013] [Indexed: 02/02/2023]
Abstract
Two patients underwent arthroscopic anatomic double-bundle anterior cruciate ligament (ACL) reconstruction using the EndoButton for femoral fixation. The femoral tunnels were created by the inside-out technique through a far anteromedial portal. The patients postoperatively developed moderate lateral knee pain without instability. At the second-look arthroscopic evaluation, the two EndoButtons were removed. Both patients were completely asymptomatic several months after implant removal, implying that the EndoButtons caused the mechanical irritation in the iliotibial band. This is the first report describing removal of EndoButtons because of pain caused by friction with the iliotibial band. In anatomic ACL reconstruction, if the femoral tunnel exit is positioned near the lateral femoral epicondyle, care should be taken to prevent iliotibial band friction syndrome that could result because of the EndoButton.
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Affiliation(s)
- Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
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Comparison of femoral tunnel length between transportal and retrograde reaming outside-in techniques in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2013; 21:830-8. [PMID: 22552615 DOI: 10.1007/s00167-012-2024-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 04/16/2012] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate the accuracy of intraoperative femoral tunnel length measurement and to compare this between the transportal (TP) and outside-in (OI) techniques for double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. METHODS Eighty patients underwent a DB ACL reconstruction using either the TP or the OI technique. The participants were randomized to either a TP group (I, 40 cases) or a OI group (II, 40 cases). The intraoperatively measured femoral tunnel length was recorded, and the postoperative femoral tunnel length was measured using computed tomography with OsiriX(®) imaging software. RESULTS The mean femoral tunnel lengths measured intraoperatively in Group II (38.9 ± 3.0 mm for anteromedial [AM], 39.3 ± 3.4 mm for posterolateral [PL]) were significantly longer than those of Group I (34.8 ± 2.7 mm for AM, 36.0 ± 3.2 mm for PL) (P < 0.001). The mean AM femoral tunnel length measured postoperatively in Group II (33.3 ± 3.8 mm) was significantly longer than that in Group I (31.1 ± 2.9 mm) (P = 0.006). The mean intraoperatively measured femoral tunnel length was significantly longer than that measured postoperatively in Groups I and II (P < 0.001). CONCLUSION After anatomic DB ACL reconstruction, the femoral tunnel length of the OI technique measured intraoperatively (AM/PL) and postoperatively (AM) was longer than those of the TP technique. The femoral tunnel length measured intraoperatively was longer than that measured postoperatively in both TP and OI technique. This study may help surgeons to measure femoral tunnel length accurately in anatomic DB ACL reconstruction with suspensory fixation device.
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Nag HL, Gupta H. Seating of TightRope RT Button Under Direct Arthroscopic Visualization in Anterior Cruciate Ligament Reconstruction to Prevent Potential Complications. Arthrosc Tech 2012; 1:e83-5. [PMID: 23766982 PMCID: PMC3678645 DOI: 10.1016/j.eats.2012.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/24/2012] [Indexed: 02/03/2023] Open
Abstract
The ACL TightRope RT (Arthrex, Naples, FL) is a recently introduced fixation device. The adjustable graft loop allows the surgeon some freedom in terms of the length of the femoral socket, eliminates the need for bothersome intraoperative calculations for selecting loop length, ensures that the socket is completely filled with graft, and provides the possibility of tensioning the graft even after graft fixation. However, the device can be associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. For example, in our experience, sometimes the button of the TightRope RT may not flip, may become jammed inside the femoral canal, or may flip in the substance of the vastus lateralis. To prevent this, we have introduced 2 additional steps in our procedure: (1) direct visualization of the TightRope RT button in the femoral socket with the arthroscope during its passage and (2) a controlled push directly on the button with the help of a guide pin. Thus proper seating of the button is ensured by direct visualization and the crucial push helps in flipping and seating of the button.
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Affiliation(s)
- Hira L. Nag
- Address correspondence to Hira L. Nag, M.S.(Orth), Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Mae T, Kuroda S, Matsumoto N, Yoneda M, Nakata K, Yoshikawa H, Shino K. Migration of EndoButton after anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 2011; 27:1528-35. [PMID: 21924859 DOI: 10.1016/j.arthro.2011.06.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 03/08/2011] [Accepted: 06/15/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to (1) assess the migration of EndoButtons (Smith & Nephew Endoscopy, Andover, MA) with or without tissue interposition by comparing the radiographs obtained immediately after anterior cruciate ligament (ACL) reconstruction and those obtained during the follow-up period and (2) investigate the effect of tissue interposition or migration of EndoButtons on the clinical outcomes. METHODS One hundred one patients underwent anatomic double-bundle ACL reconstruction with EndoButtons for femoral fixation. Anteroposterior and lateral radiographs were taken immediately postoperatively and at 1 week, 1 month, 3 months, and 1 year. The distance between the EndoButton and lateral femoral cortex was measured on the radiograph obtained immediately postoperatively, and more than 1 mm in distance was defined as positive tissue interposition. Moreover, the locations of the EndoButtons on the radiographs obtained at each follow-up visit were compared with those obtained immediately postoperatively, and EndoButton migration was considered to be present when the EndoButton had moved more than 1 mm or had rotated by more than 5°. The relations between clinical outcomes at 1 year and tissue interposition or migration of EndoButtons were also evaluated. RESULTS Tissue interposition was found for 51 EndoButtons and migration was observed for 71 EndoButtons, and there was a significant difference in the incidence of migration between anteromedial and posterolateral grafts. Of the 51 EndoButtons with tissue interposition, 32 migrated within 1 year, and 39 of 151 EndoButtons without tissue interposition migrated, whereas the EndoButtons with tissue interposition migrated significantly more frequently. On the other hand, there were no significant differences in clinical outcomes between the cases with or without tissue interposition and between the cases with or without EndoButton migration. CONCLUSIONS Tissue interposition between the EndoButton and femoral lateral cortex was found in 51 EndoButtons (25.2%) on the radiographs obtained immediately after ACL reconstruction, whereas EndoButtons with tissue interposition migrated more frequently than those without it 1 year after ACL reconstruction. However, neither tissue interposition nor migration of the EndoButton affected the clinical outcomes. LEVEL OF EVIDENCE Level IV, prognostic case series.
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Affiliation(s)
- Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Detached femoral bone plug following anterior cruciate ligament repair. Radiol Case Rep 2011; 6:586. [PMID: 27307945 PMCID: PMC4900027 DOI: 10.2484/rcr.v6i4.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report the case of a 16-year-old woman who experienced failure of her bone-patellar tendon-bone (BPTB) reconstruction of her left anterior cruciate ligament (ACL) due to detachment of the femoral bone plug from the endobutton. We have only found one prior report of this unusual complication. This case is also notable in that evidence of this complication is visible radiographically. Most postoperative complications of ACL reconstruction can be visualized only with the assistance of magnetic resonance imaging (MRI).
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Brucker PU, Zelle BA, Fu FH. Intraarticular EndoButton displacement in anatomic anterior cruciate ligament double-bundle reconstruction: A case report. ACTA ACUST UNITED AC 2005. [DOI: 10.1053/j.oto.2004.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yanmiş I, Tunay S, Oğuz E, Yildiz C, Ozkan H, Kirdemir V. Dropping of an EndoButton into the knee joint 2 years after anterior cruciate ligament repair using proximal fixation methods. Arthroscopy 2004; 20:641-3. [PMID: 15241318 DOI: 10.1016/j.arthro.2004.03.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
One of the most discussed subjects regarding anterior cruciate ligament (ACL) repair methods is femoral fixation. One of the materials often used for fixation in recent years is the EndoButton (Acufex Microsurgical, Mansfield, MA), which provides rapid and secure fixation. Although many reports about femoral fixation with EndoButton have been published, insufficient information is available on possible complications. We have used 240 EndoButtons in our clinic for ACL repairs since 1997. The goal of this study was to report a case of ACL repair with an EndoButton, in which we experienced a complication. In this case, the EndoButton dropped into the knee joint after 2 years.
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Affiliation(s)
- Ibrahim Yanmiş
- Gülhane Military Medical Academy and Faculty, Department of Orthopedics and Traumatology, Ankara, Turkey.
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Brinsden MD, Parsons SW, Peace PK. Intra-articular migration of anterior cruciate ligament graft fixation presenting as a locked knee. Injury 2003; 34:383-4. [PMID: 12719170 DOI: 10.1016/s0020-1383(02)00208-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- M D Brinsden
- Locomotor Directorate, Royal Cornwall Hospital Treliske, Truro, Cornwall TR1 3LJ, UK.
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Jansson KA, Linko E, Sandelin J, Harilainen A. A prospective randomized study of patellar versus hamstring tendon autografts for anterior cruciate ligament reconstruction. Am J Sports Med 2003; 31:12-8. [PMID: 12531751 DOI: 10.1177/03635465030310010501] [Citation(s) in RCA: 179] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone-patellar tendon-bone graft has been the most commonly used graft material in anterior cruciate reconstructions, but there has been increasing use of hamstring tendon grafts. However, no existing clinical studies show adequate support for the choice of one graft over the other. HYPOTHESIS Hamstring tendons are equally as good as patellar tendon in anterior cruciate ligament reconstructions. STUDY DESIGN Prospective randomized clinical trial. METHODS Ninety-nine patients with laxity caused by a torn anterior cruciate ligament underwent arthroscopically assisted reconstruction with graft randomization according to their birth year. Grafts were either bone-patellar tendon-bone with metal interference screw fixation or double-looped hamstring tendons with metal plate fixation. There were no significant differences between the two groups preoperatively or at operation. Standard rehabilitation included immediate postoperative mobilization without a knee brace, protected weightbearing for 2 weeks, and return to full activity at 6 to 12 months. RESULTS Forty-three patients in the patellar tendon group and 46 patients in the hamstring tendon group were available for clinical evaluation at a minimum of 21 months after surgery. No statistically significant differences were seen with respect to clinical and instrumented laxity testing, International Knee Documentation Committee Score ratings, isokinetic muscle torque measurements, and Kujala patellofemoral, Lysholm, and Tegner scores. CONCLUSION Equal results were seen for patellar and hamstring tendon autograft anterior cruciate ligament reconstructions at 2 years after surgery. Both techniques seem to improve patients' performance.
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Affiliation(s)
- Kim A Jansson
- ORTON Orthopaedic Hospital, Invalid Foundation, Helsinki, Finland
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Abstract
A case of an EndoButton drill bit failure associated with anterior cruciate ligament reconstruction using semitendinosus gracilis autograft is reported. The distal 10 mm flutes of the drill bit sheared off prior to graft passage. This event was likely related to repeated use of this bit, which is intended for single use only. This case highlights another potential pitfall associated with anterior cruciate ligament reconstruction.
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Affiliation(s)
- Mark D Miller
- Department of Orthopaedic Surgery, The University of Virginia, Charlottesville, Virginia, USA.
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