Residual antero-posterior knee laxity is not impaired by an adjustable button device. Prognostic factors leading to increased laxity after isolated ACL reconstruction.
ESSKA Academy. panisset j. May 12, 2018; 218168; FP49-1305
jean claude panisset
jean claude panisset
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Objectives: Biomechanical studies demonstrated that adjustable-loop button devices lengthen and displace after high cyclic forces. The adjustable button used in our study may not lead to increased postoperative laxity and to worse clinical results. Additional purpose was to find possible concomitant risk factors predisposing to residual laxity >3mm.

Methods: Two groups of patients with similar preoperative activity level and reconstruction of acute isolated ACL ruptures with hamstrings tendon autografts were retrospectively obtained. The groups differed only in the femoral fixation method (bio-absorbable interference screw-Screw Group, or adjustable button-Button Group. In order to compare the two fixation methods, we excluded any other predisposing factor that could increase knee laxity and influence our results. For this reason exclusion criteria were concomitant or previous meniscectomy or even meniscal repair at time of operation, surgery delay more than 6 months and revision cases.
The objective International Knee Documentation Committee (IKDC) score, the Tegner activity level and the antero-posterior laxity (Telos) were recorded preoperatively and at minimum 24 months later. The Knee injury and Osteoarthritis Outcome Score (KOOS) was obtained at the latest follow-up.

Results: A total of 272 patients with mean follow up of 26±3 months were included (Screw= 121, Button =151). The mean preoperative laxity was 6±3mm for the Button and 6±2.9mm for the Screw group (p=0.144) while the respective values for the Tegner were 6.85±1 and 6.9±1.15 (p=0.87).
The mean post-operative laxity was 1.5±2.0 mm in the Button and 2.3±2.0mm in the Screw group respectively (p=0.0004). According to objective IKDC score 87.4% of the patients in the Button and 74.4% in the Screw Group were rated as Grade A (p=0.0056). The mean post-operative scores were the following: Tegner 6.5±1.3 and KOOS 90.6±7.5 for the Button; and Tegner 6.3±1.4 and KOOS 90.6±7.4 for the Screw group (p=0.31 and p=0.76 respectively). A negative correlation was found between post-operative laxity and final Tegner (rs=-0.303, p<0.001) and KOOS scores (rs=-0.17, p=0.005).
Bivariate analysis showed that the preoperative pivot shift grade (p< 0.001), the pre-operative laxity >7mm (p=0.02) and the younger age (p=0.003) were negative prognostic factors for residual laxity >3mm. Final multivariate analysis showed that only the pivot shift remained the strongest predictor (odds ratio [OR], 4.689 for pivot 2 compared to 1 and OR=58 for pivot 3 compared to 1, p<.001).

Conclusions: The adjustable-loop button was superior in terms of post-operative laxity compared to the interference screw for femoral fixation. Nevertheless, the most important risk factor of residual knee laxity >3mm was the preoperative pivot shift grade.

ACL; adjustable button; residual laxity
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