Abstract

COMPARISON OF TRANSFIX SCREW TECHNIQUE AND ENDOBUTTON TECHNIQUE IN TERMS OF TUNNEL WIDENING AND CLINICAL RESULTS IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
ABSTRACT
Objective: The aim of the present study was to compare transfix screw technique and endobutton technique in terms of femoral and tibial tunnel enlargement and clinical outcomes in anterior cruciate ligament (ACL) surgery and was to discuss nonanatomic transtibial system under current circumstances.
Materials and Methods: This retrospective study was conducted on 50 patients who had ACL reconstruction in SCI Goztepe Training and Research Hospital between September, 1999 and March, 2003. Among the patients enrolled, 17 patients had endobutton and 33 had transfix screw technique for ACL reconstruction. The age average of the patients who have undergone ACL reconstruction through endobutton technique was 27,2 years whereas the age average of those who had transfix screw method was 29.9 years. Femoral and tibial tunnel enlargement rates were reviewed for radiological comparison. Harner’s quadrant location, Frontal femoral tunnel angles and Frontal tibial tunnel angles was similar in both groups, and they were found comparable radiologically. The differences between the early postoperative and late postoperative tunnel widths of both group were compared. Clinical comparison was performed through Hospital for Special Surgery Knee Score (HSSKS).
Findings: Tunnel widening was detected in a significant part of the cases who had both endobutton and transfix screw methods; and the cases with a tunnel dilatation difference at and over 2 mm were accepted as tunnel enlargement and evaluated in consideration of standard deviation. Consequently, significant tunnel enlargement was detected in 47% of the cases in endobutton CL reconstruction group, and in 51.5% of the cases in transfix screw technique group. There was not any statistically significant difference in tunnel enlargement between two techniques (p>0.05). In the transfix technique, the HSKSS scores of the patients with femoral tunnel width difference over 2 mm were 90,2 whereas in cases without femoral tunnel width or minimal, this score was 91,1. In Endobutton technique, HSKSS scores of the patients with the femoral tunnel enlargement were 91, HSKSS scores of the cases without femoral tunnel enlargement were 91,25. There was no relation between femoral tunnel widening and HSKSS scores due to the value of P >0,005 in Mann Whitney test. Postoperative rehabilitation period was similar in both groups; HSSKS scores of the cases who have undergone transfix and endobutton techniques were compared (Tables 9, 10). The p>0.05 meant that there was not any clinically significant difference between two groups.
Conclusion: Significant tunnel widening was found in both endobutton CL and transfix technique (using transtibial method) in ACL reconstruction with the hamstring tendon graft. However, there was no significant difference between the two techniques in terms of tunnel widening. It was observed that tunnel enlargement has no significant effect on clinical results in both groups. There was no significant difference between the two groups in terms of clinical results. Successful outcomes were obtained in ACL reconstructions through transtibial technique where extraarticular fixation was done. Recognition of both transtibial techniques for anatomic ACL reconstruction is essential for ACL revision procedures.

Key words: Transfix techniqe, Endobutton technique, Anterior cruciate ligament, Tunnel widening,Transtibial technique.