Prospective randomised comparison of femoral transfix versus endobutton with constant tibial fixation in hamstring tendon ACL reconstruction: a preliminary study

Background: The purpose of this study is to evaluate clinico radiological outcome of hamstring tendon ACL reconstruction using femoral Transfixation and Endobutton with identical Tibial fixation.Methods: A Prospective randomized clinical outcome study was done from January 2002 to June 2008, a total of 132 patients with quadruple hamstring ACL reconstruction using a femoral fixation group A Endobutton (n=68; median age=27.4) and group B with Transfix (n=64; median age=26.1) and identical Tibial fixation with Biointerference screw and bone staple were studied. Patients in each group had a clinical and radiological assessment at <3, 3-12, 12-24 and >24 months after surgery.Results: The mean Lysholm Knee score has improved significantly with time within these groups but no difference on comparison between groups. Ninety percent of all patients had functionally normal or near normal International Knee Documentation Committee (IKDC) knee ligament ratings. IKDC Subjective Knee evaluation mean score has progressively increased significantly from pre op values of 37.58 and 36.55 to about 74.51 and 75.85 in group A and group B respectively. The tibial and femoral tunnels also showed widening of about 9.64% and 7.79% in group A as compared to 7.71% and 7.27% in group B at >24 months follow-up, which was statistically insignificant. MRI done in limited patients showed good graft incorporation in both groups.Conclusions: So keeping the tibial graft fixation constant, the two different femoral fixation methods, Endobutton and transfixation have not influenced in the clinical outcome in this short term preliminary study. But long term follow up of these is necessary to evaluate the significance of tunnel widening and its final outcome