Tibial suspensory fixation has superior early subjective and objective outcomes compared with tibial screw fixation, but there are no consistent significant differences at medium-term follow-up (≥2 Years)

Abstract

This retrospective study aimed to compare suspensory and screw tibial fixation in ACL reconstruction (ACLR), assuming that adjustable suspensory tibial graft fixation (ASF) would yield better objective and subjective outcomes than fixed interference screw tibial fixation (FISF). A cohort study was conducted across two centres from 2018 to 2023. The inclusion criteria were: primary ACL reconstruction using a hamstring tendon with femoral suspensory fixation and either a bioabsorbable interference screw or adjustable suspensory fixation in the tibia, and ages between 18 and 45 years. SPSS version 20 was used to conduct statistical analyses of graft diameter, operation time, walking without aid, full ROM, time to return to sport, and IKDC and Lysholm scores. A total of 300 primary ACLRs meeting the criteria were analysed. The ASF group exhibited significantly earlier walking without aids and a faster return to sport, with higher IKDC and Lysholm scores than group FISF at 6 months of follow-up (p < 0.001). However, by the end of the study, there was no statistical difference between the two groups. Suspensory tibial fixation enables early full ROM, walking without aids, and quicker return to sports, with higher IKDC and Lysholm scores than screw fixation. However, both techniques yield similar clinical outcomes, with most patients returning to their previous activity levels after 2 years. retrospective cohort level III, retrospective comparative therapeutic trial.