Early Complications with Femoral Transcondylar Pin Fixation for ACL reconstruction

OBJECTIVES: Bioabsorbable transcondylar fixation has remained a popular femoral fixation option for anterior cruciate ligament (ACL) reconstruction using hamstring graft. We report the incidence of failure and complications related to this particular fixation device in a single surgeon consecutive series of 56 patients. METHODS: Fifty-six consecutive arthroscopic ACL reconstructions using hamstring autograft done by single surgeon between March 2010 and Dec 2011 were reviewed retrospectively after IRB approval. Transcondylar femoral fixation was achieved using Bio-Transfix (Arthrex, Naples, FL) pin in all patients. Mean follow up was 18.2 months. Intra-operative and post-operative follow up data were reviewed to assess failure. Failure was categorized as either graft failure due to re-injury or implant related failure due to persistent pain at pin insertion site and/or pin breakage. RESULTS: 13 (23.2%) patients were deemed as failures following surgery. Five patients needed revision surgery (persistent pain at pin insertion site n= 2, and pin breakage n=3). Two additional patients had a pin breakage and refused surgery and five additional patients had pain at the transfix pin site but opted for conservative treatment. One patient had a mid-substance graft failure due to sports injury unrelated to implant type. Remaining 43 patients did not report any symptoms of pain and or instability following surgery. CONCLUSION: This single surgeon consecutive series of ACL reconstruction using transcondylar pin fixation device demonstrates a slightly higher failure rate (23.2%) as compared to previous isolated reports of pin breakage or pain at insertion site in literature. Further radiographic studies are necessary to understand the natural history of osteointegration of this bio-device, such as implant thinning, tunnel widening by osteolysis, points of stress risers in implant and possible modification in routine accelerated rehabilitation following this implant as method for ACL reconstruction.