NEW SYSTEM FOR FEMORAL FIXATION (TTS) IN THE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH HAMSTRING TENDONS – 5 YEAR FOLLOW-UP.

Abstract

The chioce of the graft and its fixation in LCA reconstruction is basic for the outcome of the surgical procedure. Several solutions have been proposed; each of them had advantages and disavantages. The choice of the graft and the surgical technique is often due to surgeon’s opinion.

The goal of the fixation is stability which allowes incorporation of the graft in the bone tunnels. Bone-patellar tendon-bone graf has the advantage of bone to bone fixation which is impossible using tendon grafts. Femoral fixation techniques for hamstrings can be classified in: compression tecniques, expansion tecniques and suspension tecniques (cortical or canellous).

TTS (Top Traction System) is a new tecnique for femoral fixation using hamstrings. The fixation is achieved by a retrograde screw that allowes fixation to the antero-lateral cortex of the femur. A ring is fixed to the screw to allow tendons passing. The screw is sefl-threading, its lenght is 28 millimeters and its diameter is 6,5 millimeter; its pull-out strenght is 1350 N. The screw is built in titanium alloy and only one size.

Surgical technique is simple an reproducible and the instruments are easy to use. The positioning of the screw is fully guided by instruments that minimize errors.

This fixation device allowes further graft traction after tibial fixation without twisting hamstrings. Results after 5 years are good but we need long term follow-up for final opinion.