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Low-Profile Cortical Screw Tibial Fixation for Hamstring Anterior Cruciate Ligament Reconstruction: Surgical Technique and Stability Results

Prodromos, Chadwick M.D.

doi: 10.1097/01.bto.0000177722.15822.81

Summary: Tibial fixation is widely recognized to be the weak link in anterior cruciate ligament reconstruction. The soft cancellous bone poses challenges for intratunnel fixation, which has bred a variety of augmentations to this method. Cortical fixation is recognized as offering greater beneficial stiffness, but concerns about subcutaneous irritation of such devices has limited their use. We present a method of tibial fixation that uses a specially designed low-profile unicortical cancellous screw with a smooth shank just below the head as an anchor to whipstitches interwoven in the graft, which are then tied around the screw. This method was used in 153 consecutive knees, 139 of which were located for follow up 2 to 8 years after surgery. 86% had IKDC normal stability rates and 97% had ≤3 mm side-to-side KT 1000 differences. There were no graft failures and no clinically unstable knees. No cortical screw backed out, none were removed for symptoms, and all are still in place. There were no deep knee infections. A 1-inch long tibial incision was used. The screw is far enough from the knee that subsequent magnetic resonance images of the knee are not compromised.

From Illinois Sportsmedicine and Orthopaedic Centers, Glenview, Illinois.

Address correspondence and reprint requests to Chadwick C. Prodromos, MD, Illinois Sportsmedicine and Orthopaedic Centers, Glenview, IL. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.