Table 5. Studies on hybrid fixation in ACLR.
| Reference | Year | Study type | Study purpose | Conclusion |
|---|---|---|---|---|
| Pereira (2) | 2021 | Systematic review | Review the current evidence on tibial-graft fixation | • No consensus on the best method for tibial fixation of the grafts in ACL reconstructions regarding tension |
| Brand (7) | 2000 | Review | Review of literature on graft fixation devices | • Fixation should be done at normal anatomic attachment |
| • No consensus on best device | ||||
| Weiss (12) | 2019 | Biomechanical study | Comparative biomechanical analysis of tibial fixation strength for ACLR with interference screw compared with screw post and washer, and compared with the associated fixation of both methods (hybrid fixation) | • Hybrid fixation group presented a significantly higher final stiffness |
| • Also had a higher yield load compared to the interference screw group | ||||
| Oh (41) | 2006 | Biomechanical study | Evaluate the effect of hybrid femoral fixation with bioabsorbable interference screws | • Hybrid femoral fixation with suspensory fixation and a bioabsorbable interference screw is stronger than interference or suspensory fixation alone with respect to ultimate tensile strength, stiffness, and slippage |
| Walsh (42) | 2009 | Biomechanical study | Compare biomechanical screw/suspensory fixation versus either alone | • Combined screw/suspensory had higher load-to-failure |
| • Combined yield stiffer construct | ||||
| Verioti (43) | 2015 | Biomechanical study | Compare three methods of tibial-sided fixation | • No significant difference between IFS, IFS + post, or IFS + suture anchor |
| Athiviraham (44) | 2021 | Biomechanical study | Determine whether initial tensioning of suture tape before fixation with a knotless suture anchor significantly affects final tension of the suture tape | • Final tension of the suture tape construct appears to be reproducible and consistent, independent of the initial tension introduced with suture anchor placement |
| Eisen (45) | 2008 | Technique article | Describes transosseous backup suture fixation for ACLR | • Technique for backup tibial fixation precludes the need for external hardware |
| Carulli (46) | 2017 | Randomized controlled trial | Compare the clinical/radiological outcomes of patients with tibial fixation by a centrally placed resorbable screw/sheath to a resorbable interference screw/staple fixation | • No significant differences between groups |
| Teo (47) | 2017 | Retrospective review | Determine whether supplementary tibial graft fixation with a staple is routinely necessary for ACLR | • No significant difference in the objective and subjective outcome assessments between staple/no staple |
| Diego (48) | 2017 | Technique article | Describe femoral fixation with a combined metal IFS and staple | • Technique for combined IFS/staple femoral fixation |
| Gerich (49) | 1997 | Biomechanical study | Evaluate the primary biomechanical parameters of this technique compared with a standard IFS fixation | • Staple fixation resulted in comparable max load to failure, graft slippage, and stiffness to IFS |
ACLR, anterior cruciate ligament reconstruction; IFS, interference screw.