الفهرس 
Introduction and aim of workOnly 14 pages are availabe for public view
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Abstract
The rate of ACL injuries are increasing overtime and therefore ACL
reconstruction is now considered one of the most common procedures in
orthopedic surgeries worldwide.
Rupture of the ACL affects knee stability, resulting in giving way symptoms
in daily and sports activities, increased risk of meniscal injuries, and early
degenerative changes in the injured knee.
Different Techniques have been described over the years for ACL
reconstructions. Controversies over the graft materials and the method of graft
fixation push the surgeons towards further biomechanical and clinical studies
aiming at a better outcome of this surgical procedure.
Multiple grafts have been used in ACL reconstruction surgeries whether
allograft or auto grafts. The bone—patellar tendon—bone graft and quadrupled
hamstring tendons are the most frequently used autografts.
During the last few years, quadriceps tendon autograft has increased in
popularity as a source of autogenous graft for ACL reconstruction.
The benefits of quadriceps tendon autograft include preservation of
hamstring anatomy and function, as well as it produces fewer donor site problems
than if the patellar tendon is harvested, has excellent mechanical characteristics.
Also the graft can be used with or without a patellar bone block.
Among many factors that influence the success of ACL reconstruction
surgeries, the Method of graft fixation stands to be one of the most important
factors. The use of multiple implants has been used as a method of graft fixation.
Interference screws, Endo buttons, washer locks and rigid fix were all use to fix the
ACL graft inside either the femoral or tibial tunnels. Although each one of these
implants has its own advantages, but the complication of using foreign hardware
are many. That’s why the press-fit concept has been invented to replace the
implants used in graft fixation with bone plugs.
This concept of Press fit has been utilized in ACL reconstruction with the
use of PTB, hamstrings and quadriceps tendon. We adopted one of these
techniques in all press fit reconstruction using the quadriceps tendon as a graft.
The aim of this study was to evaluate and to compare the effectiveness of
ACL reconstruction using autologous quadriceps tendon graft and fixed by
biodegradable interference screws versus press fit technique.
from March 2012 to January 2014, 50 consecutive patients with chronic
ACL deficient knee underwent arthroscopically assisted reconstruction with
autogenous QT. 25 cases were fixed with interference screw and 25 with press fit
technique.
Preoperatively, no significant differences between the two groups were
noted with respect to age, level of activity, degree of laxity. A standardized
rehabilitation program was used for both groups. Assessment of the patients was
carried out using a questionnaire, clinical assessment, lysholm knee scores and the
international knee documentation committee scale.
Results:
Postoperatively, there was a significant improvement in both groups and
there was no significant difference between the 2 groups with respect to subjective
complaints (recurrent giving way, functional level) or return to sports after ACL
reconstruction using either method of fixation.
However there was a trend toward better stability with the screw group with
objective laxity evaluation, there was no significant difference between the two
groups with respect to returning to the normal or nearly normal state.
Conclusion & Recommendations
1- This study confirms that ACL reconstruction with QT graft and fixed with
interference screws or press fit technique restores knee stability and allows return
to a high level of functional and sports activity.
2- However there was a trend toward better stability with the screw group
with objective laxity evaluation, there was no significant difference between the
two groups with respect to returning to the normal or nearly normal state.
3- The QT is a reliable source of graft for ACL reconstruction and can be
used with or without a patellar bone block. The benefits of quadriceps tendon
autograft include preservation of hamstring anatomy and function, as well as
reduced donor site morbidity.
4- All press fit technique can be used safely and successfully in ACL
reconstruction surgeries and represent a good alternative among other options for
ACL reconstruction.
5- All press fit technique is technically demanding at the beginning and has a
less steep learning curve other than the ordinary well known techniques in ACL
reconstruction but it is a cheaper, cost effective and more biological.
6- There are no studies in the literature that have specifically compared the
outcome of the two methods. Also there are a few studies that use press fit
technique with QT graft.
7- Our study needs to be supported by more studies with more number of
patients and longer follow up periods.
8- The main drawbacks of this study are the absence of instrumented
evaluation (KT1000 testing) and the relatively short follow up periods.