Superior long-term stability and function associated with femoral cortical button versus interference screw fixation in ACL reconstruction: A systematic review and meta-analysis

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-24 DOI:10.1002/jeo2.70439

Jonathan Elias, Mitchell Kaplan, Michael Bickford, Thomas Oliver, Kunal Shah, Elizabeth Ford, Sean McMillan

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引用次数: 0

Abstract

Purpose

There are two main methods of femoral graft fixation during anterior cruciate ligament reconstruction (ACLR): cortical button (CB) and interference screws (IS). Each fixation yields its own unique outcomes; however, there is yet to be an established gold standard. We seek to compare femoral CB to IS fixation in ACLR using all soft-tissue, autograft hamstring grafts. We hypothesise that there will be no significant differences between the two methods.

Methods

A systematic review and meta-analysis were conducted following the 2020 PRISMA guidelines. PubMed, Cochrane, Embase, Web of Science and Scopus were screened for potential randomised studies. The studies must have utilised both the semitendinosus and gracilis, and utilised either metallic or bioabsorbable IS, or fixed or adjustable loop CB fixation on femoral fixation. All studies in both groups must have used interference screws on the tibial side. The 2-year follow-up analysed KT-1000 side-to-side differences, while the 5–10 year follow-up compared Lysholm and Tegner scores.

Results

A total of 12 randomised studies were included in the final systematic review, providing an evaluation of 583 distinct patients. Two of the studies were excluded from the meta-analysis, due to not providing pre- and post-operative means and standard deviations. At 2-year and 5-10 year follow-ups, the mean ages were 30.5 ± 8.7 and 30.2 ± 8.1, respectively. Analysis of the 2-year follow-up favour of CB (p = 0.01) in regards to the reduction in KT-1000 side-to-side differences. Analysis of the 5–10 year follow-up revealed favour of CB in regards to the Lysholm Score (p < 0.01), and the Tegner Score (p < 0.01).

Conclusions

At 2-years postoperatively, femoral fixation utilising cortical buttons portrayed less knee laxity than interference screws. At the 5–10 year follow-up, cortical buttons yielded more sports and work-related activity, less pain, and overall greater function than did the interference screws.

Level of Evidence

Level II.

Abstract Image

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股骨皮质钮扣与干涉螺钉固定在ACL重建中的长期稳定性和功能：一项系统回顾和荟萃分析

目的在前交叉韧带重建术（ACLR）中，股骨移植物固定主要有两种方法：皮质扣（CB）和干涉螺钉（IS）。每一种固定都会产生自己独特的结果；然而，目前还没有一个确定的黄金标准。我们试图比较在ACLR中使用所有软组织自体腘绳肌腱移植物进行股骨CB和IS固定。我们假设这两种方法之间不会有显著差异。方法根据2020年PRISMA指南进行系统评价和荟萃分析。PubMed、Cochrane、Embase、Web of Science和Scopus筛选潜在的随机研究。这些研究必须同时使用半腱肌和股薄肌，并使用金属或生物可吸收的IS，或固定或可调节的环形CB固定股骨固定。两组的所有研究必须在胫骨侧使用干涉螺钉。2年的随访分析了KT-1000的两侧差异，5-10年的随访比较了Lysholm和Tegner评分。最终的系统评价共纳入了12项随机研究，对583名不同的患者进行了评估。其中两项研究由于没有提供术前和术后的平均值和标准差而被排除在meta分析之外。随访2年和5 ~ 10年，平均年龄分别为30.5±8.7岁和30.2±8.1岁。2年随访分析表明，在降低KT-1000侧侧差异方面，CB治疗更有利（p = 0.01）。5-10年随访分析显示，在Lysholm评分（p < 0.01）和Tegner评分（p < 0.01）方面，CB更受青睐。结论术后2年，股骨内固定采用皮质钮扣比干涉螺钉表现出更少的膝关节松弛。在5-10年的随访中，与干涉螺钉相比，皮质按钮带来了更多的运动和与工作相关的活动，更少的疼痛和更大的整体功能。证据等级二级。

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