Table 3:
Clinical Outcomes and Complications
| Authors | Year | Femoral / Tibial Fixation | Outcome | Complications |
|---|---|---|---|---|
| Aperture Fixation | ||||
| Cavaignac et al. | 2017 | Intra-tunnel (Bioabsorbable Interference Screws used for both) | Lysholm: 89 +/− 6.9 KOOS: -Pain: 90 +/− 6.8 - Symptoms: 90 +/− 11.2 -ADL: 95 +/− 5.3 -Sport: 82 +/− 11.3 -QOL: 78 +/− 14.7 Tegner: -Last Follow-up: 5.9 +/− 1.4 -Difference in preoperative: 1 +/− 1.05 IKDC subjective: 84 +/− 13 Lachman (0–2): 0 (41 pts; 93.1%), 1 (4 pts; 6.9%) Pivot Shift (0–2): 0 (41 pts; 93.1%), 1 (4 pts; 6.9%) KT-1000: mean= 1.1 +/− 0.9 No. of Pts with >3mm difference: 5; 11.4% Extension Difference: 26.3 +/− 11.3 % Flexion Difference: 8.2 +/− 17.3 % |
1 re-rupture after re-trauma 3 total reoperations: Cyclops lesion (5.7 months); Femoral Screw Removal (13.1 months); Grade 3 cartilaginous injury of the medial condyle (25.2 months) |
| Geib et al. | 2009 | Intra-tunnel (Bioabsorbable interference screw / Bioabsorbable interference screw augmented with suture) | Side-to-side difference in anterior laxity with KT-1000 and manual maximum force: 0.51 mm IKDC Knee Examination Form: A = 18 (66.7%), B = 7 (25.9%), C = 2 (7.4%), D = 0 (0%) 23/41(56.0%) of patients had single-leg hop distances greater than 90% contralateral knee Flexion Deficit: 0.12° Extension Deficit: 0.41° Positive Pivot Shift: 0 (0%) |
Graft Failure: 1 (2%) Post-operative effusion: 0 (0%) |
| Gorschewsky et al. | 2007 | Intra-tunnel (Bioabsorbable interference screws used for both) | IKDC: A (11%), B (72%), C (17%), D (0%) Donor Site Morbidity: Normal (85%), Nearly Normal (15%). Radiographic Findings: Normal Joint Space (19; 20%), Joint Space <4 mm (61; 66%), Joint Space 2–4 mm (13; 14%), Joint Space <2mm (0) One-leg hop test: 82; 89% normal Lysholm Score: 94 +/− 9 Return to Sport: 76 pts (81%) |
2 pts (2.2%): Graft Rupture from re-trauma (18 months post-op) |
| Han et al. | 2008 | Intra-tunnel (Metal interference screw / Bioabsorbable Interference Screw) | Lysholm: Preop (70.7) vs Postop (91.5) Cybex II: At 6m (n=34): 60 degree/second (%) 59 ± 15 (n=19); 180 degree/second (%) 62 ± 17. At 1 year (n=25): 60 degree/second (%) 78 ± 13 (n=19); 180 degree/second (%) 82 ± 11. At 2 years: 60 degree/second (%) 82 ± 15 (n=19); 180 degree/second (%) 89 ± KT-1000: < 3: 48 (66.6%); 3–5: 21 (29.2%), 5–10: 3 (4.2%), >10: ROM: extension deficit < 5 degree: 3 (4.17%); extension deficit of 10 degrees: 1 (1.39%); flexion deficit of 10 degrees: 2 (2.78%); flexion deficit of 40 degree: 1 (1.39%) IKDC: Preoperative: I (strenuous): 38; II (moderate): 57; III (light): 5; IV (sedentary) 0 Postoperative: I (strenuous): 28; II (moderate): 56; III (light): 16; IV (sedentary) 0 IKDC Subjective Satisfaction: Grades: (A) Normal or (B) Nearly Normal: 66 patients (92%) |
Of the two patients with graft failure in the QTPB group, one had a traumatic rupture, which occurred while playing soccer 45 months after surgery, and the other graft failed from an unknown etiology (without a history of distinct injury), and the patient then underwent reoperation 30 months after surgery. |
| Joseph et al. | 2006 | Intra-tunnel (Bioabsorbable interference screw augmented with bone disk anchor / Bioabsorbable interference screw) |
Time to attainment of full extension: 3.9 weeks Time to attainment of straight leg raise without lag: 3.7 weeks Time to attainment of 120° of flexion while prone: 4.7 weeks |
None recorded |
| Kim et al. | 2009 | Intra-tunnel (Bioabsorbable interference screws used for both) | Preoperative Lachman (7, 24% Grade 3; 22, 76% Grade 2) vs Postoperative Lachman (20, 69% Grade 0; 9, 31% Grade 1) Preoperative Pivot-shift test (1, 3% Grade 3, 25, 86% Grade 2; 3, 10% Grade 1) vs Postoperative (29, 100% Grade 0) KT-2000 Postop assessment: (Mean +/− St. Dev (mm)= 2.03+1.11)/Side to side diff: <3 mm= 23, 79%; 3–5 mm=6,21%; >5 mm= 0,0%) Preop HSS Score (65.7 +/− 11.4) vs Postop HSS score (92.1 +/− 6.1) Preop Lysholm (51.7 +/− 10.7) vs Postop Lysholm (91.1 +/− 6.8) |
1 pt.: posterior femoral cortex perforated during fixation of anteromedial bundle 1 pt.: fixed patellar bone plug in tibial tunnel migrated proximally during pre-tensioning of graft |
| Kim et al. | 2009 | Intra-tunnel (Bioabsorbable interference screws used for both) | Postoperative Lachman: (17, 81% Grade 0; 2, 19% Grade 1; 2, 19% Grade 2) Postoperative Pivot Shift: (17, 85.7% Grade 0; 2, 14.3% Grade 1; 2, 14.3% Grade 2) KT-2000: Side to side difference: (<3 mm, 12; 3–5 mm, 6; >5 mm, 3) IKDC Score: Preinjury: (A, 9, 44%; B, 12, 56%) vs Follow-up: (A, 8, 38%; B, 10, 48%, C, 3, 14%) |
No Complications Reported |
| Kim et al. | 2009 | Intra-tunnel (Bioabsorbable interference screws used for both) | Postoperative Lachmann: Grade 0: 17, 81% Grade 1: 2, 19% Grade 2: 2 (19%) Grade 3: 0, 0% Postoperative Pivot Shift: Grade 0: 17, 85.7% Grade 1: 2, 14.3% Grade 2: 2, 14.3% Grade 3: 0, 0% Single-leg hop test: 17 pts (81%) KT-2000: <3 mm (12 pts) 3–5 mm (6 pts) >5 mm *3 pts) Anterior knee pain score: 90.2 IKDC A: Preop (9, 44%) vs Postop (8, 38%) B: Preop (12, 56%) vs Postop (12, 48%) C: preop (0, 0%) vs Postop (3, 14%) D: Preop (0) vs Postop (0) |
2 pts (9%) reported mild discomfort at the quadriceps tendon graft site |
| Kwak et al. | 2018 | Intra-Tunnel (Metal Interference Screw used for both) | Anterior Drawer Test: Preoperative (Grade 0, 4, 8.9%; Grade 1, 15, 33.3%; Grade 2, 21, 46.7%, Grade 3, 5, 11.1%) vs Postoperative (Grade 0, 32, 71.1%; Grade 1, 13, 28.9%; Grade 2, 0, 0.0%; Grade 3, 0, 0.0%) Lachman Test: Preoperative (Grade 0, 3, 6.7%; Grade 1, 14, 31.3%; Grade 2, 19, 42.2%, Grade 3, 9, 20.0%) vs Postoperative (Grade 0, 29, 64.4%; Grade 1, 15, 33.3%; Grade 2, 1, 2.2%; Grade 3, 0, 0.0%) Pivot Shift Test: Preoperative (Grade 0, 4, 8.9%; Grade 1, 22, 48.9%; Grade 2, 14, 31.1%, Grade 3, 5, 11.1%) vs Postoperative (Grade 0, 29, 64.4%; Grade 1, 16, 35.6%; Grade 2, 0, 0.0%; Grade 3, 0, 0.0%) KT-2000 (mm): Preoperative (4.5 +/− 1.8) vs Postoperative (1.4 +/− 1.2) KT-2000: <3 mm: Preop (5, 11.1%) vs Postop (34, 75.6%) 3–5 mm: Preop (30, 66.7%) vs Postop (11, 24.4%) >5 mm: Preop (10, 22.2%) vs Postop (0, 0%) IKDC score: Preop (42.7 +/− 22.6) vs Postop (67.3 +/− 16.8) Lysholm Score: Preop (62.4 +/− 8.4) vs Postop (87.0 +/− 5.3) Tegner Scale: Preop (2.8, 1.8–4) vs Postop (7.2, 6.3–8.2) KOOS: Preop (273.8 +/− 87.5) vs Postop (423.1 +/− 50.9) |
2 pts had paresthesia on lateral side of knee (disappeared after 2 months) 3 pts had clicking sensation in knee during activities (relieved after 3 months) |
| Lee et al. | 2007 | Intra-tunnel (Metal interference screw / bioabsorbable interference screw) | Lachmann Test: Negative (113, 82.48%) Pivot Shift: Grade 0 (100, 73%) Lysholm: Preoperative (73.5) vs Postoperative (93) Cybex: Preop (76.2%) vs Postop (84.70%) KT-1000: Preop (7.1 mm) vs Postop (2.4 mm) ROM: Preop (137.8 degrees) vs Postop (139.5 degrees) Flexion Contracture: Preop (0.8 Degrees) vs Postop (0.6 Degrees) |
Graft Rupture: 3 (2.19%) |
| Lee et al. | 2007 | Intra-tunnel (Metal interference screw, Bioabsorbable Interference Screw) | Lysholm: Preop (71) vs Postop (90) KT-1000: Preop (6.2 ± 2.5 mm (mean + SD); < 3: 43 (18%); 3–5: 92 (38%), 6–10: 103 (43%), >10: 2 (1%) vs Postop ( 2.4 ± 1.7 mm (mean + SD); < 3: 162 (68%); 3–5: 67 (28%), 6–10: 11 (5%), >10: 0) ROM: Preop (137.3) vs Postop ( 137.5° (mean); 234 (97.5%) had extension deficit of <3°; 235 (97.9%) had lack of flexion of <5° at latest follow-up) IKDC: 209 Pts (87.0%) were Grade A or B IKDC levels of activity: Strenuous of moderate (211) IKDC Knee Grade: Grade A or B, 212 pts (88.3%) |
Graft Rupture: 7/247 ruptures (4 traumatic, 3 graft failure) |
| Lee et al. | 2016 | Intra-tunnel (Metal interference screw / Bioabsorbable interference screw) | Anterior Drawer Test: Grade 0: Preop (5) vs Postop (34) Grade 1: Preop (25) vs Postop (13) Grade 2: Preop (15) vs Postop (1) Grade 3: Preop (3) vs Postop (0) Lachman Test: Grade 0: Preop (6) vs Postop (32) Grade 1: Preop (23) vs Postop (15) Grade 2: Preop (17) vs Postop (1) Grade 3: Preop (2) vs Postop (0) Pivot Shift Test: Grade 0: Preop (12) vs Postop (32) Grade 1: Preop (15) vs Postop (16) Grade 2: Preop (19) vs Postop (0) Grade 3: Preop (2) vs Postop (0) KT-2000 side-to-side difference mm: Preop (70.2 +/− 9.6) vs Postop (92.1 +/− 8.7) Tegner Activity Score: Preoperative (4.6 +/− 1.8) vs Postop (4.7+/− 1.2) IKDC Subjective Score: Preop (60.3 +/− 17.8) vs Postop (80.2 +/− 10.0) Extensor Strength (60 deg/s) 1-year (71.9 +/− 24.4) vs 2-year (81.0 +/− 17.7) Extensor Strength (180 deg/s) 1-year (73.5 +/− 25.1) vs 2-year (83.8 +/− 17.8) Flexor Strength (60 deg/s) 1-year (87.0 +/− 15.7) vs 2-year (92.2 +/− 17) Flexor Strength (180 deg/s) 1-year (94.6 +/− 17.1) vs 2-year (99.6 +/− 15.0) |
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| Lee et al. | 2004 | Intra-tunnel (Metal interference screw / Bioabsorbable Interference Screw) | Lachman Test: Preop (Grade 1: 10; Grade 2: 52; Grade 3: 5) vs Postop (Grade 0: 47; Grade 1: 17; Grade 2: 3) Anterior Drawer Test: Preop (Grade 1: 11; Grade 2: 50; Grade 3: 6) vs Postop (Grade 0: 50; Grade 1: 14; Grade 2: 3) Pivot Shift Test: Preop (Grade 1: 11; Grade 2: 42; Grade 3: 14) vs Postop (Grade 0: 41; Grade 1: 23; Grade 2: 3) KT-2000: <2 mm: Preop (0%) vs Postop (75%) 3–5 mm: Preop (15%) vs Postop (19%) 6–10 mm: Preop (77%) vs Postop (6%) >10 mm: Preop (8%) vs Postop (0%) Final IKDC: I (13%), II (75%), III (12%), IV (0%) Overall Knee Function Subjective Score: -Normal (45%) - Nearly Normal (42%) - Abnormal (12%) - Severe (1%) Quadriceps strength (Cybex II): - 60degrees/sec: Preop (72 +/− 14%) vs 6 Mo (64+/−15%) vs 12 Mo (82+/−13%) vs 24 Mo (82+/−15%) - 180 degrees/sec: Preop (78+/−11%) vs 6 Mo (74+/−20%) vs 12 Mo (82+/−13%) vs 24 Mo (89+/−8%) |
4 pts: Revision ACLR (6%) |
| Lund et al. | 2014 | Intra-tunnel (Titanium interferences crews used for both) | Average KOOS Score: Preoperative (65 +/− 20) vs 1 Year (68 +/− 21) vs 2 years (82 +/− 16) Subjective IKDC Score: Preoperative (68 +/− 14) vs 1 Year (76 +/− 16) vs 2 Years (84 +/− 13) KT-1000 Side to side difference (1.1 +/− 1.4 mm) <2 mm AP laxity (77%) 3–4 mm (19%) >5 mm (4%) Positive Pivot Shift at 1 year: (14%) |
48% of pts experienced crural sensitivity loss of 39 cm2 1 pt.: Early superficial infection treated successfully with IV antibiotics 1 pt.: Medial pain 2 years postop with inflamed medial plica that upon resection resulted in relief of symptoms. |
| Sofu et al. | 2013 | Intra-tunnel (metal interference screw / bioabsorbable interference screw) | Lysholm Score: <64 (poor): Preop (22, 95.6%) vs Postop (1, 4.3%) 65–83 (Fair): Preop (1, 4.4%) vs Postop (2, 8.7%) 84–94 (Good): Preop (0, 0%) vs Postop (14, 60.8%) 95–100 (Excellent): Preop (0, 0%) vs Postop (6, 26.2%) Single Leg Hop Test: 10 pts, 43.5% could achieve 90% performance at follow-up KT-2000: Operated knee joint laxity mm: 5.65 (3.5–8.0); Health knee joint laxity mm: 2.86 (1.5–4.0) |
|
| Theut et al. | 2003 | Intra-tunnel (Bioabsorbable interference screw augmented with bone disk anchor / Bioabsorbable interference screw) |
Side-to-side difference in anterior laxity with KT-1000 and manual maximum force: 2.1 m | Graft Failure: 4 (5.9%) |
| Suspensory Fixation | ||||
| Chen et al. | 1999 | Intra-tunnel (Metal Interference Screw / Bicortical Screw and Washer) | IKDC Categories: Subjective: (5 normal, 5 nearly normal, 2 abnormal) Symptoms (5 normal, 6 nearly normal, 1 abnormal) ROM (9 normal, 2 nearly normal, 1 abnormal) Laxity (5 normal, 6 nearly normal, 1 abnormal) Crepitus (9 normal, 2 nearly normal, 1 abnormal) Donor Site (10 normal, 1 nearly normal, 1 abnormal) X-ray (11 normal, 1 nearly normal) Functional Test (4 normal, 6 nearly normal, 2 abnormal) Overall Final Rating (7 normal, 3 nearly normal, 2 abnormal) KT-1000 Results: (<3mm=5 pts; 4–5 mm=6 pts; >5 mm=1 pt.) 100-point knee scale (Mean w range=86.5, 81–93) 11/12 patients recovered quadriceps strength to 80% of normal knee after 1 year Mean Quadriceps isokinetic percentage = 86% (71–105%) |
1 pt.: Mild harvest site tenderness 1 pt.: Patellofemoral pain |
| Chen et al. | 2006 | Intra-tunnel (Interference screw / Bicortical screw and washer?) | Lysholm knee scores: Preoperative Mean +/− SD (61.4 +/− 8.9) vs Postoperative Mean +/− SD (93.0 +/− 7.9) IKDC Activity Level: Pre-operative Activity level (Strenous:5; Moderate: 4; Light: 6; Sedentary: 19) vs Postoperative Activity (Strenuous: 17; Moderate: 9; Light: 5; Sedentary: 3) Anterior Knee Laxity (KT-1000 test): Preoperative Mean +/− SD (11.88 +/− 1.09) vs Postoperative (1.74+/− 1.80) Lachman Test: Preoperative (24 Grade III; 10 Grade IV) vs Postoperative (30 Grade I; 3 Grade II; 1 Grade III) Thigh Girth: (Preoperative (14.26 +/− 5.69 mm) vs Last Follow-up (9.65 +/− 5.53); p<0.01) Extensor Strength Ratio: Preoperative (79.71 +/− 8.06) vs Postoperative (91.65 +/− 8.09) mm; p<0.01 Flexor Strength Ratio: Preoperative (82.62 +/− 9.25) vs Follow-up (90.18 +/− 8.59) mm; p<0.01) |
Two patients sustained stitch abscesses at incision wound that needed retrieval of stiches. Two complained of numbness at lateral side of original tibial incision. One complained of irritation of tibial screw head that was removed later. |
| Guimaraes et al. | 2009 | Intra-tunnel (Metal interference screw / Cancellous screw with washer) | Lysholm: 1st year (98.71 +/− 2.47) vs 10th year (97.35 +/− 3.12) HSS Score: 1st year (95.07 +/− 5.23) vs 10th year (94.87 +/− 4.16) 16 patients: Thigh diameter 2 cm lower than other leg Lachmann test negative in 13 pts (76.47%) Anterior drawer test negative in 12 pts (70.59%) No decreases in patellofemoral joint space in any patients |
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| Iriuchishima et al. | 2017 | Extra-tunnel (Cortical button / Cortical plate and screw) |
IKDC Knee Examination Form: A=18 (90%), B = 2 (10%), C = 0 (0%), D = 0 (0%) Mean anterior tibial translation on stress radiograph: 1.0 +/− 0.8 mm Positive Pivot Shift: 0 (0%) Mean quadriceps strength pre-operatively and 3, 6, 9, 12 months post-operatively (compared to contralateral extremity): 90.5 ± 19, 67.8 ± 21.4, 84 ± 17.5, 87.5 ± 15, and 85.1 ± 12.6 % Mean hamstrings strength pre-operatively and 3, 6, 9, 12 months post-operatively (compared to contralateral extremity): 99.5 ± 13.7, 78.7 ± 11.4, 90.5 ± 19, 91 ± 10.3 and 96.7 ± 13.8 % |
Graft Site Pain: 0 (0%) |
| Runer et al. | 2018 | Extra-Tunnel (Endobutton / Hybrid Interference Screw with Endotack) | Lysholm: Pre-injury (94.7 +/− 8.2) vs 6 Mo (87.2 +/− 10.4) vs 12 Mo (88.8 +/− 10.6) vs 24 Mo (93.4 +/− 7.5) VAS Pain: Pre-injury (0.90 +/− 1.1) vs 6 Mo (1.6 +/− 1.8) vs 12 Mo (1.2 +/− 1.4) vs 24 Mo (0.6 +/− 1.0) Tegner Score: Pre-injury (6; 1–9) vs 6 Mo (6; 3–9) vs 12 Mo (6; 3–9) vs 24 Mo (6; 2–9) Return to Activity: 6 months (80%), 12 Months (80%), 24 Months (67%) |
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