Research progress on the graft fixation methods of femoral side in anterior cruciate ligament reconstruction
10.3760/cma.j.cn121113-20240810-00449
- VernacularTitle:前十字韧带重建术中移植物股骨端固定方式的研究进展
- Author:
Mengyang JIA
1
;
Weiyi CHEN
1
;
Ying YANG
1
;
Xianxiang XIANG
1
Author Information
1. 大连大学附属新华医院运动医学科，大连 116021
- Publication Type:Journal Article
- Keywords:
Arthroscopy;
Anterior cruciate ligament;
Anterior cruciate ligament reconstruction;
Tenodesis
- From:
Chinese Journal of Orthopaedics
2025;45(6):380-386
- CountryChina
- Language:Chinese
-
Abstract:
Anterior cruciate ligament (ACL) injury of the knee is a common sports injury that leads to knee instability, articular cartilage degeneration, periarticular ligaments and meniscus injuries. Arthroscopic anterior cruciate ligament reconstruction (ACLR) is the gold standard in the treatment of ACL injuries, but femoral fixation, being one of the main factors affecting postoperative function after ACLR, remains controversial with various methods and no universal standard. Interference screws as a commonly used fixation method are made of various materials, among which metal screws provide strong fixation but have the disadvantages of graft damage, interference with the MRI examination, and a removal surgery. Degradable metal has good mechanical properties but its degradation is unpredictable. Bioabsorbable interference screws do not require a second operation and do not interfere with the MRI examination, but there are risks of screw breakage, dislocation, and bone tunnel widening. Sheathed interference screws increase the tendon-bone contact area but require a high level of integrity of the bone tunnel. Suspension fixation, the most commonly used method for ACLR femoral side, provides high initial strength, but may cause tendon lengthening, wiper effect and bungee effect. Cross-pin fixation such as Rigidfix, fixes the graft with two absorbable transverse nails with even stress distribution. However, it has a limited choice of femoral tunnel location,poses a risk of cross-pin fracture, and is not suitable for patients with tendons smaller than 7 mm in diameter. Over-the-top fixation does not need the building of a femoral tunnel and is more commonly used in skeletally immature, partial ACL injuries and ACLR revision surgery, where damage to the epiphysis can be avoided and can be used as a means of reinforcement. However, it is not sufficient in patients with high requirements for knee flexion stability and requires longer tendon graft.
