Reconstrucción primaria de ligamento cruzado anterior usando botón autoajustable, autobloqueante. Resultados clínicos y radiológicos luego de un seguimiento mínimo de 36 meses
DOI:
https://doi.org/10.63403/re.v33i2.477Palabras clave:
Ligamento cruzado anterior, Fijación femoral, Botón cortical ajustable, Resultados clínicos, Artroscopia, TenZ®Resumen
Introducción: la reconstrucción del ligamento cruzado anterior (LCA) depende en gran medida de la estabilidad inicial del injerto y del método de fijación femoral utilizado. Los sistemas ajustables convencionales pueden presentar elongación del lazo bajo carga cíclica (loop creep), con riesgo de pérdida de tensión y ensanchamiento del túnel óseo.
Objetivos: evaluar los resultados clínicos y radiológicos obtenidos con el uso de un botón femoral ajustable autobloqueante en la reconstrucción primaria del ligamento cruzado anterior con seguimiento mínimo de 36 meses.
Material y métodos: se realizó un estudio ambispectivo (nivel de evidencia IV) que incluyó 50 pacientes consecutivos sometidos a reconstrucción primaria del LCA con autoinjerto de isquiotibiales y fijación femoral con botón autobloqueante. Se analizaron las escalas IKDC, Lysholm y Tegner, además de la evolución radiológica (tamaño del túnel, posición del botón) y la resonancia magnética a los 9 meses. El seguimiento mínimo fue de 36 meses.
Resultados: los puntajes IKDC, Lysholm y Tegner mejoraron significativamente (58.2→94.8; 62.4→93.7; 3.1→6.8; p <0.001). No se registraron fallas del injerto, complicaciones ni ensanchamiento del túnel (Δ <0.3 mm). La resonancia magnética demostró ligamentización completa y consolidación ósea en el 100 % de los casos. El retorno deportivo promedio fue de 8.5 meses, con recuperación funcional total.
Conclusión: el botón femoral ajustable autobloqueante proporcionó fijación estable, ausencia de complicaciones y resultados clínicos reproducibles a 36 meses, constituyendo una alternativa confiable a los sistemas de lazo fijo tradicionales.
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Schützenberger S, Keller F, Grabner S, et al. ACL reconstruction with femoral and tibial adjustable versus fixed-loop suspensory fixation: a retrospective cohort study. J Orthop Surg Res. 2022;17(1):244. doi: https://www.doi.org/10.1186/s13018-022-03128-y. DOI: https://doi.org/10.1186/s13018-022-03128-y
Smith PA, Stannard JP, Pfeiffer FM, Kuroki K, Bozynski CC, Cook JL. Suspensory versus interference screw fixation for arthroscopic anterior cruciate ligament reconstruction in a translational large-animal model. Arthroscopy. 2016;32(6):1086-97. doi: https://www.doi.org/10.1016/j.arthro.2015.11.026. DOI: https://doi.org/10.1016/j.arthro.2015.11.026
Colombet P, Graveleau N, Jambou S. incorporation of hamstring grafts within the tibial tunnel after anterior cruciate ligament reconstruction: magnetic resonance imaging of suspensory fixation versus interference screws. Am J Sports Med. 2016;44(11):2838-2845. doi: https://www.doi.org/10.1177/0363546516656181. DOI: https://doi.org/10.1177/0363546516656181
Tomihara T, Ohashi H, Yo H. Comparison of direct and indirect interference screw fixation for tendon graft in rabbits. Knee Surg Sports Traumatol Arthrosc. 2007;15(1):26-30. doi: https://www.doi.org/10.1007/s00167-006-0118-6. DOI: https://doi.org/10.1007/s00167-006-0118-6
Tibor L, Chan PH, Funahashi TT, Wyatt R, Maletis GB, Inacio MC. Surgical technique trends in primary acl reconstruction from 2007 to 2014. J Bone Joint Surg Am. 2016;98(13):1079-89. doi: https://www.doi.org/10.2106/JBJS.15.00881. DOI: https://doi.org/10.2106/JBJS.15.00881
Lawhorn KW, Howell SM. Principles for using hamstring tendons for anterior cruciate ligament reconstruction. Clin Sports Med. 2007;26(4):567-85. doi: https://www.doi.org/10.1016/j.csm.2007.07.002. DOI: https://doi.org/10.1016/j.csm.2007.07.002
Robindro P, Latchumi NVK, Kanthimathi BD. To Study the functional outcome of arthroscopic acl reconstruction using hamstring graft fixed with endobutton for femur and interference screw and suture post for tibial fixation. Int J Med Dental Sci. 2016;5:978-983. DOI: https://doi.org/10.19056/ijmdsjssmes/2016/v5i1/83539
Smith TO, Davies L, Hing CB. Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2010;18(3):304-11. doi: https://www.doi.org/10.1007/s00167-009-0965-z. DOI: https://doi.org/10.1007/s00167-009-0965-z
Eysturoy NH, Nissen KA, Nielsen T, Lind M. the influence of graft fixation methods on revision rates after primary anterior cruciate ligament reconstruction. Am J Sports Med. 2018;46(3):524-530. doi: https://www.doi.org/10.1177/0363546517748924. DOI: https://doi.org/10.1177/0363546517748924
Sonnery-Cottet B, Rezende FC, Martins Neto A, Fayard JM, Thaunat M, Kader DF. Arthroscopically confirmed femoral button deployment. Arthrosc Tech. 2014;3(3):e309-12. doi: https://www.doi.org/10.1016/j.eats.2014.01.007. DOI: https://doi.org/10.1016/j.eats.2014.01.007
Mayr R, Smekal V, Koidl C, et al. ACL reconstruction with adjustable-length loop cortical button fixation results in less tibial tunnel widening compared with interference screw fixation. Knee Surg Sports Traumatol Arthrosc. 2020;28(4):1036-1044. doi: https://www.doi.org/10.1007/s00167-019-05642-9. DOI: https://doi.org/10.1007/s00167-019-05642-9
Jin C, Paluvadi SV, Lee S, Yoo S, Song EK, Seon JK. Biomechanical comparisons of current suspensory fixation devices for anterior cruciate ligament reconstruction. Int Orthop. 2018;42(6):1291-1296. doi: https://www.doi.org/10.1007/s00264-018-3780-7. Erratum in: Int Orthop. 2018;42(4):977. doi: https://www.doi.org/10.1007/s00264-018-3849-3.
Chang MJ, Bae TS, Moon YW, Ahn JH, Wang JH. A comparative biomechanical study of femoral cortical suspension devices for soft-tissue anterior cruciate ligament reconstruction: adjustable-length loop versus fixed-length loop. Arthroscopy. 2018;34(2):566-572. doi: https://www.doi.org/10.1016/j.arthro.2017.08.294. DOI: https://doi.org/10.1016/j.arthro.2017.08.294
Nye DD, Mitchell WR, Liu W, Ostrander RV. biomechanical comparison of fixed-loop and adjustable-loop cortical suspensory devices for metaphyseal femoral-sided soft tissue graft fixation in anatomic anterior cruciate ligament reconstruction using a porcine model. Arthroscopy. 2017;33(6):1225-1232.e1. doi: https://www.doi.org/10.1016/j.arthro.2016.12.014. DOI: https://doi.org/10.1016/j.arthro.2016.12.014
Smith PA, Piepenbrink M, Smith SK, Bachmaier S, Bedi A, Wijdicks CA. Adjustable- versus fixed-loop devices for femoral fixation in ACL reconstruction: an in vitro full-construct biomechanical study of surgical technique-based tibial fixation and graft preparation. Orthop J Sports Med. 2018;6(4):2325967118768743. doi: https://www.doi.org/10.1177/2325967118768743. DOI: https://doi.org/10.1177/2325967118768743
Ahn HW, Seon JK, Song EK, Park CJ, Lim HA. comparison of clinical and radiologic outcomes and second-look arthroscopic findings after anterior cruciate ligament reconstruction using fixed and adjustable loop cortical suspension devices. Arthroscopy. 2019;35(6):1736-1742. doi: https://www.doi.org/10.1016/j.arthro.2019.01.051. DOI: https://doi.org/10.1016/j.arthro.2019.01.051
Boyle MJ, Vovos TJ, Walker CG, Stabile KJ, Roth JM, Garrett WE Jr. Does adjustable-loop femoral cortical suspension loosen after anterior cruciate ligament reconstruction? A retrospective comparative study. Knee. 2015;22(4):304-8. doi: https://www.doi.org/10.1016/j.knee.2015.04.016. DOI: https://doi.org/10.1016/j.knee.2015.04.016
Choi NH, Yang BS, Victoroff BN. Clinical and radiological outcomes after hamstring anterior cruciate ligament reconstructions: comparison between fixed-loop and adjustable-loop cortical suspension devices. Am J Sports Med. 2017;45(4):826-831. doi: https://www.doi.org/10.1177/0363546516674183. DOI: https://doi.org/10.1177/0363546516674183
Heijne A, Fleming BC, Renstrom PA, Peura GD, Beynnon BD, Werner S. Strain on the anterior cruciate ligament during closed kinetic chain exercises. Med Sci Sports Exerc. 2004;36(6):935-41. doi: https://www.doi.org/10.1249/01.mss.0000128185.55587.a3. DOI: https://doi.org/10.1249/01.MSS.0000128185.55587.A3
Houck DA, Kraeutler MJ, McCarty EC, Bravman JT. Fixed- Versus Adjustable-loop femoral cortical suspension devices for anterior cruciate ligament reconstruction: a systematic review and meta-analysis of biomechanical Studies. Orthop J Sports Med. 2018;6(10):2325967118801762. doi: https://www.doi.org/10.1177/2325967118801762. DOI: https://doi.org/10.1177/2325967118801762
Jin C, Paluvadi SV, Lee S, Yoo S, Song EK, Seon JK. Biomechanical comparisons of current suspensory fixation devices for anterior cruciate ligament reconstruction. Int Orthop. 2018;42(6):1291-1296. doi: 10.1007/s00264-018-3780-7. Erratum in: Int Orthop. 2018 Apr;42(4):977. doi: https://www.doi.org/10.1007/s00264-018-3849-3. DOI: https://doi.org/10.1007/s00264-018-3780-7
Johnson JS, Smith SD, LaPrade CM, Turnbull TL, LaPrade RF, Wijdicks CA. A biomechanical comparison of femoral cortical suspension devices for soft tissue anterior cruciate ligament reconstruction under high loads. Am J Sports Med. 2015;43(1):154-60. doi: https://www.doi.org/10.1177/0363546514553779. DOI: https://doi.org/10.1177/0363546514553779
Kawakami H, Shino K, Hamada M, et al. Graft healing in a bone tunnel: bone-attached graft with screw fixation versus bone-free graft with extra-articular suture fixation. Knee Surg Sports Traumatol Arthrosc. 2004;12(5):384-90. doi: https://www.doi.org/10.1007/s00167-003-0484-2. DOI: https://doi.org/10.1007/s00167-003-0484-2
Noonan BC, Dines JS, Allen AA, Altchek DW, Bedi A. Biomechanical evaluation of an adjustable loop suspensory anterior cruciate ligament reconstruction fixation device: The Value of Retensioning and Knot Tying. Arthroscopy. 2016;32(10):2050-2059. doi: https://www.doi.org/10.1016/j.arthro.2016.02.010. DOI: https://doi.org/10.1016/j.arthro.2016.02.010
Pasquali M, Plante MJ, Monchik KO, Spenciner DB. A comparison of three adjustable cortical button ACL fixation devices. Knee Surg Sports Traumatol Arthrosc. 2017;25(5):1613-1616. doi: https://www.doi.org/10.1007/s00167-015-3711-8. DOI: https://doi.org/10.1007/s00167-015-3711-8
Nag HL, Gupta H. Seating of tightrope rt button under direct arthroscopic visualization in anterior cruciate ligament reconstruction to prevent potential complications. Arthrosc Tech. 2012;1(1):e83-5. doi: https://www.doi.org/10.1016/j.eats.2012.03.003. DOI: https://doi.org/10.1016/j.eats.2012.03.003
Kamien PM, Hydrick JM, Replogle WH, Go LT, Barrett GR. Age, graft size, and Tegner activity level as predictors of failure in anterior cruciate ligament reconstruction with hamstring autograft. Am J Sports Med. 2013;41(8):1808-12. doi: https://www.doi.org/10.1177/0363546513493896. DOI: https://doi.org/10.1177/0363546513493896
Ranjan R, Gaba S, Goel L, et al. In vivo comparison of a fixed loop (EndoButton CL) with an adjustable loop (TightRope RT) device for femoral fixation of the graft in ACL reconstruction: A prospective randomized study and a literature review. J Orthop Surg (Hong Kong). 2018;26(3):2309499018799787. doi: https://www.doi.org/10.1177/2309499018799787. DOI: https://doi.org/10.1177/2309499018799787
Khan RM, Prasad V, Gangone R, Kinmont JC. Anterior cruciate ligament reconstruction in patients over 40 years using hamstring autograft. Knee Surg Sports Traumatol Arthrosc. 2010;18(1):68-72. doi: https://www.doi.org/10.1007/s00167-009-0888-8. DOI: https://doi.org/10.1007/s00167-009-0888-8
Xu Y, Li F, Lu H. [Reconstruction of anterior cruciate ligament with different grafts under arthroscope in 68 cases]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007;21(11):1163-6. Chinese.
Ibrahim SA, Al-Kussary IM, Al-Misfer AR, Al-Mutairi HQ, Ghafar SA, El Noor TA. Clinical evaluation of arthroscopically assisted anterior cruciate ligament reconstruction: patellar tendon versus gracilis and semitendinosus autograft. Arthroscopy. 200;21(4):412-7. doi: https://www.doi.org/10.1016/j.arthro.2004.12.002. DOI: https://doi.org/10.1016/j.arthro.2004.12.002
Tomita F, Yasuda K, Mikami S, Sakai T, Yamazaki S, Tohyama H. Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction. Arthroscopy. 2001;17(5):461-76. doi: https://www.doi.org/10.1053/jars.2001.24059. DOI: https://doi.org/10.1053/jars.2001.24059
Wise BT, Patel NN, Wier G, Labib SA. Outcomes of ACL reconstruction with fixed versus variable loop button fixation. Orthopedics. 2017;40(2):e275-e280. doi: https://www.doi.org/10.3928/01477447-20161116-04. DOI: https://doi.org/10.3928/01477447-20161116-04
Kilinc BE, Kara A, Celik H, Oc Y, Camur S. Evaluation of the accuracy of Lachman and Anterior Drawer Tests with KT1000 ın the follow-up of anterior cruciate ligament surgery. J Exerc Rehabil. 2016;12(4):363-7. doi: https://www.doi.org/10.12965//jer.1632622.311. DOI: https://doi.org/10.12965//jer.1632622.311
Shahpari O, FallahKezabi M, Kalati HH, Bagheri F, Ebrahimzadeh MH. Clinical outcome of anatomical transportal arthroscopic anterior cruciate ligament reconstruction with hamstring tendon autograft. Arch Bone Jt Surg. 2018;6(2):130-139.
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Derechos de autor 2026 Horacio Rivarola, Cristian Collazo, Marcos Palanconi, Marcos Meninato, Francisco Endara Urresta, Lorena Michel, Bautista Rivarola
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Esta obra se publica bajo una Licencia Creative Commons Atribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0). Los autores conservan los derechos de autor.
