Interference screw

All ACL reconstructions were performed according to national guidelines, and a uniform postoperative rehabilitation protocol was prescribed for all participants [21 ].
Patients underwent ACL reconstruction with a semitendinosus and gracilis tendon. Due to an institutional change in treatment protocol two surgical techniques were performed. First we used a transtibial reconstruction technique (TT), for non-anatomical ACL reconstruction. The graft is fixated using the transfix on the femoral side and an interference screw on the tibial side (Arthrex Inc., Naples, FL, USA). The other technique was anteromedial portal (AMP) [22 (link)], for anatomical ACL reconstruction. The graft is fixated using an endobutton on the femoral side and an interference screw on the tibial side (Smith & Nephew, Andover, MA, USA).

For the autograft reconstruction, the semitendinosus and gracilis tendons were harvested and prepared as a 4-stranded or 6-stranded hamstring autograft. If the combined diameter of the autograft tendons was less than 8 mm, the γ-irradiated tibialis anterior allograft was used as augmentation to achieve a minimum desired diameter of 8 mm. In the allograft group, the γ-irradiated tibialis anterior allograft was prepared as a 2-stranded or 4-stranded graft. All the allografts were irradiated at a dose of 2.5 Mrad, and supplied by a certified tissue bank (Shanxi OsteoRad Biomateral Co., Ltd., Taiyuan, China).
Diagnostic arthroscopy was performed to identify the ACL tear. The combined meniscal injuries were addressed as needed before ACL reconstruction. The ACL remnant was generally preserved. All patients underwent anatomic single-bundle ACL reconstruction, with the femoral and tibial tunnel placed in the center of the femoral and tibial ACL insertion sites. The tunnel diameter was equal to the graft tendon diameter. The graft was then pulled into both tunnels from tibia to femur. The femoral side was fixed with a TightRope device (Arthrex, Naples, FL, USA), and the tibial side was fixed with an interference screw (Arthrex, Naples, FL, USA).

SP [21 (link), 22 (link)] is considered to be the more common technique, and was therefore considered to be the control technique. IA [23 (link)] was considered to be the intervention group. Eligible patients were randomly allocated to one of the two groups with the help of the random block method with four patients in each block. General anesthesia was performed in all patients while in the beach chair position. Conditions of the shoulder joint, level of rotator cuff, and biceps tendon lesions were visualized via a lateral port. The rotator cuff was repaired with a suture anchor number 5 mm (Arthrex Inc., Naples, FL, USA). The same suture was also crossed along the damaged biceps tendon. LHBT was tenodesed to greater tuberosity, and it was detached from the glenoid. In the SP group, a 2-cm incision was created distal to the pectoral major muscle and, after crossing the guidewire, the biceps tendon was tenodesed to the bicipital groove using an interference screw of appropriate size (Arthrex Inc., Naples, FL, USA).