# Supplementary Tibial Fixation for Anterior Cruciate Ligament (ACL) Reconstruction Using Quadrupled Semitendinosus Graft: A Retrospective Study

## TL;DR

This study compares a new supplementary tibial fixation technique with standard methods in ACL reconstruction surgeries, finding improved knee stability and outcomes with the new method.

## Contribution

A novel supplementary tibial fixation technique using a transosseous tunnel with a quadrupled semitendinosus graft is introduced and evaluated.

## Key findings

- The supplementary fixation group showed significantly better Lysholm knee scores, IKDC scores, and Lachman test results.
- The supplementary fixation group had better VAS, Pivot test, and thigh atrophy outcomes, though not statistically significant.
- The technique is safe, effective, and cost-efficient, eliminating the need for additional hardware.

## Abstract

Background

Anterior cruciate ligament (ACL) reconstruction has seen significant advancements, but challenges remain, particularly in tibial fixation. Low bone density and prolonged osseous integration of soft tissue grafts compromise fixation, especially in the Indian population. We present a novel technique for supplementary ACL fixation using a transosseous tibial tunnel with a quadrupled semitendinosus graft, eliminating the need for additional hardware and associated complications.

Purpose

The purpose of this study was to compare clinical and functional outcomes of the addition of supplementary fixation with transosseous tibial tunnel with ongoing or prevailing standard bioscrew tibial fixation in ACL reconstruction surgeries using semitendinosus and gracilis graft.

Methodology

The study design was a retrospective review. Eighty-eight patients who underwent anterior cruciate ligament (ACL) reconstruction at our institution between 2019 and 2022 by the same surgeon and met the inclusion criteria were divided into two groups and were followed for 2 years postoperatively. The standard group, comprising 40 patients, underwent bioscrew for tibial fixation, and 48 patients of the supplementary fixation group underwent additional transosseous tibial tunnel fixation along with bioscrew. The outcomes, including Lysholm knee score, International Knee Documentation Committee (IKDC) score, Lachman test, Pivot score, Visual Analog Score (VAS), and thigh atrophy, were measured and compared at the final follow-up.

Results

Significant improvements were seen in the functional knee scores post-operatively in both groups, with significantly better results in the supplementary fixation group compared to the standard group for the Lysholm knee score, IKDC score, and Lachman test. The supplementary fixation group was also found to have better results for VAS, Pivot test, and thigh atrophy; however, the results were not significant.

Conclusion

Supplementary fixation with transosseous tibial tunnel is a safe, effective, and cost-efficient method for improving knee stability and clinical outcomes. The technique also eliminates the risk of symptomatic hardware complications, as was found in several previous studies, and avoids the need for extra implants, reducing overall treatment costs