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ACL reconstruction: Endobutton versus interference screw fixation
ABSTRACTS 3%, fair in 5%, and poor in 12%. Complications included loss of motion requiring manipulation under anesthesia in 3 shoulders, RSD in 2, one synovial fistula, and one suprascapular nerve injury. Conclusions: We concluded that arthroscopically assisted transglenoid suture fixation is an attractive alternative to open reconstruction of the shoulder for chronic anterior instability. The technique is particularly effective in the skeletally mature overhand athlete with arthroscopic findings of capsular laxity and no Bankart lesion.
ACL Reconstruction: Endobutton Versus Interference Screw Fixation. Omer A. Ilahi, Ben K. Graf, and Kris Jensen. Houston, Texas, and Madison, Wisconsin, U.S.A. To evaluate the preliminary results of patellar tendon anterior cruciate ligament (ACL) reconstruction using endobutton femoral fixation compared with interference screw fixation, a retrospective study was performed. The operative reports of 97 consecutive ipsilateral patellar tendon ACL reconstructions in which tibial fixation consisted of a 9 × 20 mm interference screw and femoral fixation consisted of either a 7 × 20 mm interference screw or an endobutton were reviewed. All procedures had been performed using a single incision endoscopic technique by the senior author. Patients with a history of contralateral ACL pathology or surgery were excluded as were those with multiligamentous injuries other than an ACL/MCL combination. Included were patients with prior or concurrent meniscal, chondral, and synovial pathology or surgery. Postoperatively, each patient was placed on a standard ACL reconstruction rehabilitation protocol emphasizing early motion (especially terminal extension), early weight bearing, strengthening, and propioception. Eighty-four patients fulfilled the inclusion criteria and 59 (70%) of them had instrumented knee laxity measurements (KT-1000) at a minimum of 24 weeks after surgery. Because the two surgical procedures compared in the study differed only in the method of femoral fixation, a minimum follow-up of 24 weeks was selected as it was felt that biologic fixation should be complete well before 6 months and any differences in results attributable to initial fixation should be apparent by then. Of the 59 patients, 27 had interference screw femoral fixation and 32 had endobutton femoral fixation. There was no significant difference between the two groups with regard to age, gender, side, meniscal surgery, or
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length of follow-up. The average follow-up was 38 weeks (range, 24 to 67 weeks) and there were no complications or significant reinjuries. The final range of motion measurement was similar for both groups averaging 141 ° (range, 120 ° to 170 °) for the endobutton group and 143 ° (range, 125 ° to 160 °) for the interference screw group. The side-to-side differences on manual maximum KT-1000 testing were similar for both groups averaging 2.3 mm (range, - 2 to 8 mm) for the endobutton group and 2.6 mm (range, - 3 to 10 mm) for the interference screw group. Arranging the KT-1000 results into intervals, 23 (72%) of the endobutton group had -<3 mm side-to-side difference, 6 (19%) had > 3 mm but -<5 mm difference, and 3 (9%) had > 5 mm difference. The corresponding values for the interference screw group are 17 (63%), 4 (15%), and 6 (22%). The data suggest that ACL reconstruction may be performed using an endobutton for femoral fixation without significantly altering the short-term postoperative course.
Arthroscopic Treatment of Lateral Epicondylitis: A Clinical Study. Timothy R. Stapleton and Champ L. Baker, Jr. Evans and Columbus, Georgia, U.S.A. We present the surgical technique for arthroscopic release of the extensor carpi radialis brevis and compare this technique with Nirschl's open release in a small series of patients. Fourteen patients (15 elbows) were treated nonoperatively for lateral epicondylitis for an average of 11 months. When nonoperative treatment failed, they were surgically treated and were followed for a minimum of 2 years. Five elbows were treated with an arthroscopic release, and 10 with an open surgical release using Nirschl's technique. The patients were placed in the prone position for the arthroscopic release. We used a proximal medial viewing portal and an anterolateral operating portal. The extensor carpi radialis brevis origin was released using an arthroscopic shaver, and the lateral epicondyle was decorticated with a burr. Operative time, associated pathology, cost of surgery, time lost from work, complications, and overall patient satisfaction were also assessed. There were three failure, all in workers' compensation patients, that required a revision operation. One failure (20%) was in the arthroscopic release group, and two (20%) failures were in the open group. There was a clear trend for patients with an arthroscopic release to return to work and sports faster than patients Arthroscopy, Vol 12, No 3, 1996
ACL Reconstruction: Endobutton Versus Interference Screw Fixation. Omer A. Ilahi, Ben K. Graf, and Kris Jensen. Houston, Texas, and Madison, Wisconsin, U.S.A. To evaluate the preliminary results of patellar tendon anterior cruciate ligament (ACL) reconstruction using endobutton femoral fixation compared with interference screw fixation, a retrospective study was performed. The operative reports of 97 consecutive ipsilateral patellar tendon ACL reconstructions in which tibial fixation consisted of a 9 × 20 mm interference screw and femoral fixation consisted of either a 7 × 20 mm interference screw or an endobutton were reviewed. All procedures had been performed using a single incision endoscopic technique by the senior author. Patients with a history of contralateral ACL pathology or surgery were excluded as were those with multiligamentous injuries other than an ACL/MCL combination. Included were patients with prior or concurrent meniscal, chondral, and synovial pathology or surgery. Postoperatively, each patient was placed on a standard ACL reconstruction rehabilitation protocol emphasizing early motion (especially terminal extension), early weight bearing, strengthening, and propioception. Eighty-four patients fulfilled the inclusion criteria and 59 (70%) of them had instrumented knee laxity measurements (KT-1000) at a minimum of 24 weeks after surgery. Because the two surgical procedures compared in the study differed only in the method of femoral fixation, a minimum follow-up of 24 weeks was selected as it was felt that biologic fixation should be complete well before 6 months and any differences in results attributable to initial fixation should be apparent by then. Of the 59 patients, 27 had interference screw femoral fixation and 32 had endobutton femoral fixation. There was no significant difference between the two groups with regard to age, gender, side, meniscal surgery, or
365
length of follow-up. The average follow-up was 38 weeks (range, 24 to 67 weeks) and there were no complications or significant reinjuries. The final range of motion measurement was similar for both groups averaging 141 ° (range, 120 ° to 170 °) for the endobutton group and 143 ° (range, 125 ° to 160 °) for the interference screw group. The side-to-side differences on manual maximum KT-1000 testing were similar for both groups averaging 2.3 mm (range, - 2 to 8 mm) for the endobutton group and 2.6 mm (range, - 3 to 10 mm) for the interference screw group. Arranging the KT-1000 results into intervals, 23 (72%) of the endobutton group had -<3 mm side-to-side difference, 6 (19%) had > 3 mm but -<5 mm difference, and 3 (9%) had > 5 mm difference. The corresponding values for the interference screw group are 17 (63%), 4 (15%), and 6 (22%). The data suggest that ACL reconstruction may be performed using an endobutton for femoral fixation without significantly altering the short-term postoperative course.
Arthroscopic Treatment of Lateral Epicondylitis: A Clinical Study. Timothy R. Stapleton and Champ L. Baker, Jr. Evans and Columbus, Georgia, U.S.A. We present the surgical technique for arthroscopic release of the extensor carpi radialis brevis and compare this technique with Nirschl's open release in a small series of patients. Fourteen patients (15 elbows) were treated nonoperatively for lateral epicondylitis for an average of 11 months. When nonoperative treatment failed, they were surgically treated and were followed for a minimum of 2 years. Five elbows were treated with an arthroscopic release, and 10 with an open surgical release using Nirschl's technique. The patients were placed in the prone position for the arthroscopic release. We used a proximal medial viewing portal and an anterolateral operating portal. The extensor carpi radialis brevis origin was released using an arthroscopic shaver, and the lateral epicondyle was decorticated with a burr. Operative time, associated pathology, cost of surgery, time lost from work, complications, and overall patient satisfaction were also assessed. There were three failure, all in workers' compensation patients, that required a revision operation. One failure (20%) was in the arthroscopic release group, and two (20%) failures were in the open group. There was a clear trend for patients with an arthroscopic release to return to work and sports faster than patients Arthroscopy, Vol 12, No 3, 1996