DOS BULLETIN - Dansk Ortopædisk Selskab

2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 96
Serial Dilation reduces Graft Slippage compared to
Extraction Drilling in Anterior Cruciate Ligament
Reconstruction:
A Randomized Controlled Trial using
Radiostereometric Analysis
OG Sørensen, K Larsen, BW Jakobsen, TB Hansen, M Lind, K Søballe
University Hospital of Aarhus; Hospital Unit West;
Hamlet Private Hospital
Background: The hamstring tendon graft has become increasingly popular
in anterior cruciate ligament reconstruction because of low donorsite
morbidity. However, the tibial fixation is considered problematic,
partly because of low tibial mineral bone density.
Purpose: This study tested the hypothesis that serial dilation of the tibial
tunnel could provide a stronger anchorage of the graft-fixation-device
complex compared to traditional extraction drilling.
Methods: Forty patients (22 males and 18 females) undergoing ACL
reconstruction were randomized to either extraction drilling (group ED)
or compaction by serial dilation (group SD) of the tibial tunnel. Tantalum
beads were placed in the tibia, femur, and in the hamstring graft.
Radiostereometric analysis (RSA) were performed postoperatively and
again after 6, 12, and 24 weeks. Migration of graft in the bone tunnels as
well as knee laxity was assessed using RSA and a TELOS stress device.
Findings: Six patients (3 males and 3 females) were excluded during
follow-up, which resulted in 17 patients in group ED (median age: 30
years (range: 20 – 50)) and 17 patients in group SD (median age: 32
years (range: 20 – 49)). The mean migration of the graft at in the tibial
bone canal after 3 months was 1.3 (SD 0.6) mm, in group ED and 0.8
(SD 0.5) mm in group SD (P = 0.02). The overall knee laxity after 3
months was 13.0 (SD 4.0) mm in group ED and 10.9 (SD 3.1) mm in
group SD.
Conclusion: This study found significantly less slippage of the hamstring
graft in the tibial bone canal in the serial dilated group compared
to the extraction drilling group. The clinical relevance of the difference
is unknown. No difference in stress radiographic knee laxity was found
between the 2 groups.
96