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Author Topic: ACL Recon OS used staples instead of screws because of soft bones ??  (Read 6677 times)

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Offline joval

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I'm a 59 yeaqr old woman.  I was diagnosed with osteopenia a few years ago.  It was something my OS knew before doing my surgery.

It will be one week tomorrow since I had my ACL reconstruction.  When I spoke to my surgeon after surgery he said he had to make a change in the procedure.  My bones were too soft and the screw would not secure itself into my bone to hold the new ACL.  He said he used two staples.  I don't want to look for trouble but there's a reason surgeons practice techniques over and over.  I didn't really get a good answer when I asked if he had done this before and how do we know it will hold.

Has anyone else encountered something like this.  When I picture stapling or screwing anything, the screw is stronger every time.
01/12  Fell
02/12  MRI ACL tear
04/12  RK ACL recon Allograft, meniscus trim

Offline emergRN

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #1 on: April 25, 2012, 01:04:33 AM »
Hi Jo!

I found this abstract on PubMed:

    Performing your original search, acl graft staples, in PubMed will retrieve 63 records.

Knee Surg Sports Traumatol Arthrosc. 1997;5(2):84-8.
Pullout strength of tibial graft fixation in anterior cruciate ligament replacement with a patellar tendon graft: interference screw versus staple fixation in human knees.
Gerich TG, Cassim A, Lattermann C, Lobenhoffer HP.
Source

Trauma Department, Hannover Medical School, Germany.
Abstract

The endoscopic single incision technique for anterior cruciate ligament (ACL) reconstruction with a femoral half-tunnel may lead to a graft/tunnel mismatch and subsequent protrusion of the block from the tibial tunnel. The typical tibial fixation with an interference screw is not possible in these cases. Fixation with staples in a bony groove inferior to the tunnel outlet can be used as an alternative technique. Current literature does not provide biomechanical data of either fixation technique in a human model. This study was performed to evaluate the primary biomechanical parameters of this technique compared with a standard interference screw fixation of the block. Fifty-five fresh-frozen relatively young (mean age 44 years) human cadaver knee joints were used. Grafts were harvested from the patellar tendon midportion with bone blocks of 25 mm length and 9 mm width. A 10-mm tibial tunnel was drilled from the anteromedial cortex to the center of the tibial insertion of the ACL. Three different sizes of interference screws (7 x 30, 9 x 20, 9 x 30 mm) were chosen as a standard control procedure (n = 40). For tibial bone-block fixation the graft was placed through the tunnel, and the screw was then inserted on the cancellous or the cortical surface, respectively. Fifteen knees were treated by staple fixation. A groove was created inferior to the tunnel outlet with a chisel. The bone block was fixed in this groove with two barbed stainless steel staples. Tensile testing in both groups was carried out under an axial load parallel to the tibial tunnel in a Zwick testing machine with a velocity of 1 mm/s. Dislocation of the graft and stiffness were calculated at 175 N load. Maximum load to failure using interference screws varied between 506 and 758 N. Load to failure using staples was 588 N. Dislocation of the graft ranged between 3.8 and 4.7 mm for interference screw fixation and was 4.7 mm for staples. Stiffness calculated at 175 N load was significantly higher in staple fixation. With either fixation technique, the recorded failure loads were sufficient to withstand the graft loads which are to be expected during the rehabilitation period. Staple fixation of the bone block outside of the tunnel resulted in a fixation strength comparable to interference screw fixation.

PMID:
    9228314
    [PubMed - indexed for MEDLINE]

Publication Types, MeSH Terms
LinkOut - more resources

According to this study, you should be OK

W
« Last Edit: April 25, 2012, 01:13:05 AM by emergRN »
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline joval

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #2 on: April 25, 2012, 01:13:31 AM »
Thank you W!!  That makes me feel so much better.  I searched the web but came up empty. Nice having a Medical Pro on board!  Now I can relax and put all my energy to rehab!

Take care.
Jo
01/12  Fell
02/12  MRI ACL tear
04/12  RK ACL recon Allograft, meniscus trim

Offline Snowy

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #3 on: April 25, 2012, 01:15:42 AM »
Did your OS definitely use staples instead of the screws? I ask because my OS used a staple for additional fixation at the tibial end of the graft. When I saw it on an x-ray a year or so after the surgery, I was very surprised by the size of it - it's not a little thing like I was imagining, but a huge piece of metal that goes almost the whole way through my shin. I'm just wondering if your surgeon used the staples to secure the graft until enough new bone grows in to hold the screws in place in the tunnels, or if they're your only method of fixation.

Even with screws, you have to be very careful with the fixation in early rehab. My OS warned me that it's quite easy to rip the graft away from the screws until the tunnels have completely filled in with bone, which takes several months. If your fixation is weaker, you may have to protect the graft for longer. I know with endobuttons (an alternate fixation technique which uses a little button that sits on the outside of the bone to hold the graft in place) there's a risk of something called the "bungee effect" with hamstring grafts, where the graft stretches because of the distance between the graft and the fixation. From what I understand, the best way to minimize this risk is through very careful management of the pace of rehab, in particular avoiding lateral movements until new bone growth makes the fixation more secure. I would encourage you to check with your surgeon to find out exactly how this impacts your rehab and recovery - and then make 100% certain that the physiotherapist you're working with understands if the rehab program has to be modified as a result.

Sorry - not really a very informative answer. I hope your surgeon or his staff can shed more light on this. In the meantime, at least I can tell you that my staple seemed to do its job well. :)
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline emergRN

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #4 on: April 25, 2012, 01:17:11 AM »
Jo, take it from me...you will find something else to worry about..lol!  What else is there to do when you are laid up with only your mind running crazy, and a computer at hand!  We all do it!  You question everything.  I know I do.  My GP calls me a patient and a half :o

Snowy, I knew you were going to post on this..lol!  I was hoping you would!

Jo, your safest best is to follow your rehab protocol to the letter!

W
« Last Edit: April 25, 2012, 01:19:30 AM by emergRN »
Rt.knee scope-1990-91Dx with Partial ACL tear
Rt. ACLr with hamstring graft-2010
Rt. knee scope- partial lateral menisectomy and plica excision 2010
ACL revision quad tendon graft- 2011 
Rt. Knee partial lateral menisectomy, debridement 2012
Rt. knee partial lateral menisectiomy, debridement 2014

Offline Snowy

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #5 on: April 25, 2012, 05:26:38 AM »
In case you're curious, here's one of the xray images of my staple. I hope the size of it is additional reassurance that it's a pretty substantial piece of fixation. :)
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline joval

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #6 on: April 25, 2012, 02:21:48 PM »
Thanks so much.

 Snowy, he did say "instead" of screws.  I paid him an unexpected visit Monday. My PT thought my leg was more swollen than it should be. It was also very warm. He had me see my OS after just to make sure it wasn't DVT.  My OS said he overreacted and my swelling was normal. He seemed irritated and planned to talk with my PT.  I was fine with my PT overreacting.  Better than missing something.

While there I tried to get him to better explain the use of staple over screw.  He explained one end is held in a fish hook manor and that anchors the ACL and he used "Two" staples instead of a screw on the end.  He was answering my questions with one foot out the door.

I had a bunionectomy along with a couple of other procedures done on both feet a few years ago.  Even though they broke a lot of bones in my feet and placed 3 screws in each foot, that was less painful than this.  MY OS for that was wonderful. If you asked a question he pulled up a chair and let you continue to ask away questions until you were 100% comfortable.  He has me totally spoiled as what to expect from Doctors.  Sadly, feet is all he works with. 

Thanks for the information.  My friends yahoo and google were letting me down. 

Take care.
Jo
01/12  Fell
02/12  MRI ACL tear
04/12  RK ACL recon Allograft, meniscus trim

Offline Rothera

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #7 on: April 25, 2012, 02:52:38 PM »
Hi Jo

Nothing to add but I'm just quite interested to see someone else with "soft bones". I had no idea until after surgery and it wasn't a big deal but I have staples rather than screws for the same reason as you....and I hadn't come across this before.

R
2011 big knee blow out! ACL rupture, lat meniscus rupture, MCL rupture 3rd degree. ACLr June plus meniscus repair. All Failed Sept 2011. Attempted ACLr and MCL Oct. bone cavitation = bone grafting. March 2012ACLr plus MCL graft with allograft. June LOAR. Clot. Wash out.
March 2013 skiing

Offline joval

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #8 on: April 25, 2012, 03:25:42 PM »
Hi R,

Thanks for responding.  I take it you haven't had any problems with the use of staples?  That is so good to hear. 

Do you take Hi R,

Thanks for responding.  I take it you haven't had any problems with the use of staples?  That is so good to hear. 

Do you take osteoprosis meds?  I have been fighting them for a few years. Wondering if I should give in.  My dentist is totally against them for me.  I have had deep infections caused by dental problems. So I fall in that category of those that should avoid them.
My OS said what he saw overrides that.  I'm still not convinced.  I've read about the problems and I want to be very informed before I start taking one of those drugs.

Remind me why woman live longer than me?
Almost time for heel slides!
Take care.
Jo meds?  I have been fighting them for a few years. Wondering if I should give in.  My dentist is totally against them for me.  I have had deep infections caused by dental problems. So I fall in that catergory of those that should avoid them.
My OS said what he saw overrides that.  I'm still not convinced.  I've read about the problems and I want to be very informed before I start taking one of those drugs.

Almost time for heel slides!
Take care.
Jo
01/12  Fell
02/12  MRI ACL tear
04/12  RK ACL recon Allograft, meniscus trim

Offline Rb28

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #9 on: July 01, 2012, 03:33:37 AM »
Hi, I had my Acl surgery. & was told that staples were placed instade of screws due to soft bones. Now its been 3 wks. I hv been told not to bend my knee at all. So there is no motin I my knees . I hv to keep the brace on all the time until I see the os on 6 th next wk.

I m really worried if I will be able to bend my knee at all as I hv been keeping it just straight for all these days nearly for 20 days. Pls reply

Offline Rb28

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Re: ACL Recon OS used staples instead of screws because of soft bones ??
« Reply #10 on: July 01, 2012, 04:29:14 AM »
I'm a 59 yeaqr old woman.  I was diagnosed with osteopenia a few years ago.  It was something my OS knew before doing my surgery.

It will be one week tomorrow since I had my ACL reconstruction.  When I spoke to my surgeon after surgery he said he had to make a change in the procedure.  My bones were too soft and the screw would not secure itself into my bone to hold the new ACL.  He said he used two staples.  I don't want to look for trouble but there's a reason surgeons practice techniques over and over.  I didn't really get a good answer when I asked if he had done this before and how do we know it will hold.

Has anyone else encountered something like this.  When I picture stapling or screwing anything, the screw is stronger every time.


Hi Jo. I had the same issue. Had my acl surgery on 13 June 2012. Not allowed to bend my knee at all. So no motion in my knees. I started walking I'll bit but it pains.I will see my os on 6th. After 3 wks of my surgery.
Do u think there will be a problem in bending my knees.