Skip to main content

History and Techniques of Material-Free and Press-Fit ACL Reconstruction

  • Chapter
  • First Online:
Press-Fit Fixation of the Knee Ligaments
  • 179 Accesses

Abstract

This chapter presents the history, biomechanical evidence, surgical techniques, and results of press-fit anterior cruciate ligament (ACL) reconstruction, particularly including the evolution of the most developed of all press-fit methods, its creation, and the special steps necessary to use all common grafts with self-adapted tension of the graft on the knee joint. Owing to the dominance of industry-specific, material-based ACL technology, it was and is not easy to spread it, despite very good results. Individual activities and political initiatives, and the necessary luck until the actual establishment of a scientific working group are demonstrated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G. ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc. 2005;13(4):248–55.

    Article  CAS  Google Scholar 

  2. Felmet G. Implant-free press-fit fixation for bone-patellar tendon-bone ACL reconstruction: 10-year results. Arch Orthop Trauma Surg. 2010;130(8):985–92.

    Article  Google Scholar 

  3. Felmet G. Implant-free anterior cruciate ligament reconstruction with diamond instruments. A biological and anatomic method for every ligament transplantation. Unfallchirurg. 2010;113(8):621–8.

    Article  CAS  Google Scholar 

  4. Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH. Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy. 2011;27(5):653–65.

    Article  Google Scholar 

  5. Horstmann H, Felmet G, Tegtbur U, Krettek C, Jagodzinski M. Influence on graft choice between hamstring and quadriceps tendon on muscle function in implant free ACL reconstruction. DKOU; 28 October–31, 2014, Berlin.

    Google Scholar 

  6. Horstmann H, et al. Quadriceps and hamstring tendon autografts in ACL reconstruction yield comparably good results in a prospective, randomized controlled trial. Arch Orthop Trauma Surg. 2022;142(2):281–9.

    Google Scholar 

  7. Barie AHJ, Streich NA. Implant-free replacement of the anterior cruciate ligament – quadriceps tendon versus patellar tendon – long-term results of a prospective randomized clinical study. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):34.

    Google Scholar 

  8. Akoto R, Hoeher J. Anterior cruciate ligament (ACL) reconstruction with quadriceps tendon autograft and press-fit fixation using an anteromedial portal technique. BMC Musculoskelet Disord. 2012;13:161.

    Article  Google Scholar 

  9. Akoto R, Albers M, Balke M, Bouillon B, Hoher J. ACL reconstruction with quadriceps tendon graft and press-fit fixation versus quadruple hamstring graft and interference screw fixation – a matched pair analysis after one year follow up. BMC Musculoskelet Disord. 2019;20(1):109.

    Article  Google Scholar 

  10. Dargel J, Schmidt-Wiethoff R, Schmidt J, Koebke J. Histomorphology and microradiography of quadriceps tendon-patellar bone grafts in press-fit anterior cruciate ligament reconstruction. J Orthop Res. 2005;23(5):1206–10.

    Article  Google Scholar 

  11. Dargel J, Schmidt-Wiethoff R, Bruggemann GP, Koebke J. The effect of bone tunnel dilation versus extraction drilling on the initial fixation strength of press-fit anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg. 2007;127(9):801–7.

    Article  Google Scholar 

  12. Barie A, Kopf M, Jaber A, Moradi B, Schmitt H, Huber J, et al. Long-term follow-up after anterior cruciate ligament reconstruction using a press-fit quadriceps tendon–patellar bone autograft. BMC Musculoskelet Disord. 2018;19(1):368.

    Article  Google Scholar 

  13. Arnold MP, Burger LD, Wirz D, Goepfert B, Hirschmann MT. The biomechanical strength of a hardware-free femoral press-fit method for ACL bone-tendon-bone graft fixation. Knee Surg Sports Traumatol Arthrosc. 2017;25(4):1234–40.

    Article  CAS  Google Scholar 

  14. Musahl V, Abramowitch SD, Gabriel MT, Debski RE, Hertel P, Fu FH, et al. Tensile properties of an anterior cruciate ligament graft after bone-patellar tendon-bone press-fit fixation. Knee Surg Sports Traumatol Arthrosc. 2003;11(2):68–74.

    Article  Google Scholar 

  15. Lee MC, Jo H, Bae TS, Jang JD, Seong SC. Analysis of initial fixation strength of press-fit fixation technique in anterior cruciate ligament reconstruction. A comparative study with titanium and bioabsorbable interference screw using porcine lower limb. Knee Surg Sports Traumatol Arthrosc. 2003;11(2):91–8.

    Article  Google Scholar 

  16. Schmidt-Wiethoff R, Dargel J, Gerstner M, Schneider T, Koebke J. Bone plug length and loading angle determine the primary stability of patellar tendon-bone grafts in press-fit ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006;14(2):108–11.

    Article  CAS  Google Scholar 

  17. Dargel J, Schmidt-Wiethoff R, Schneider T, Bruggemann GP, Koebke J. Biomechanical testing of quadriceps tendon-patellar bone grafts: an alternative graft source for press-fit anterior cruciate ligament reconstruction? Arch Orthop Trauma Surg. 2006;126(4):265–70.

    Article  Google Scholar 

  18. Geiges B, von Falck C, Knobloch K, Haasper C, Meller R, Krettek C, et al. Biodegradable screw versus a press-fit bone plug fixation for ACL reconstruction: a prospective randomized study. Unfallchirurg. 2013;116(2):109–17.

    Article  CAS  Google Scholar 

  19. Jones KG. Reconstruction of the anterior cruciate ligament. A technique using the central one-third of the patellar ligament. J Bone Joint Surg Am. 1963;45:925–32.

    Article  CAS  Google Scholar 

  20. Clancy WG, Nelson DA, Reider B, Narechania RG. Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers. J Bone Joint Surg Am. 1982;64(3):352–9.

    Article  Google Scholar 

  21. Creenshaw AH. Campbells’s operative orthopaedics. Mosby, St. Louis – Washington D.C. – Toronto; 1987, pp. 2263–417.

    Google Scholar 

  22. Brückner H. A new method for plastic surgery of cruciate ligaments. Z Alle Gebiete Oper Medizen. 1966;37(9):413–4.

    Google Scholar 

  23. Passler HH. History of implant-free anterior cruciate ligament reconstruction. Unfallchirurg. 2010;113(7):524–31.

    CAS  Google Scholar 

  24. Hertel P. Anatomic reconstruction of the ACL: a new technique for ACL replacement. 4th ESSKA Congress; Stockholm, 1990.

    Google Scholar 

  25. Felmet G, Soni A, Becker R, Musahl V. Press-fit ACL reconstruction. In: Controversies in the technical aspects of ACL reconstruction: an evidence-based medicine approach. Cham: Springer; 2017. p. 247–61.

    Chapter  Google Scholar 

  26. Hertel P, Behrend H. Implant-free anterior cruciate ligament reconstruction with the patella ligament and press-fit double bundle technique. Unfallchirurg. 2010;113(7):540–8.

    Article  CAS  Google Scholar 

  27. Hertel P. Specific techniques in recent knee ligament surgery. Editions Scientifiques et Medicales Elsevier SAS (Paris) Surgical Techniques in Orthopaedics and Traumatology. 2001;55-530-C-10, 2000, 8 p.

    Google Scholar 

  28. Hertel P. Technique of an open ACL reconstruction with autologous patella tendon. Arthroskopie. 1997;10:240–5.

    Google Scholar 

  29. Bernard M, Hertel P, Hornung H, Cierpinski T. Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg. 1997;10(1):14–21. discussion 22

    CAS  Google Scholar 

  30. Wuchech HB. ACL reconstruction with frontosagittal approach. 6th Congress AGA – Society for Arthroscopy and Joint Surgery (German speaking Association for Arthroskopy) in Lucerne (Switzerland) 13–14 October 1989; Lucerne (Switzerland).

    Google Scholar 

  31. Boszotta H. Arthroscopic anterior cruciate ligament reconstruction using a patellar tendon graft in press-fit technique: surgical technique and follow-up. Arthroscopy. 1997;13(3):332–9.

    Article  CAS  Google Scholar 

  32. Boszotta H. Arthroscopic reconstruction of anterior cruciate ligament using BTB patellar ligament in the press-fit technique. Surg Technol Int. 2003;11:249–53.

    Google Scholar 

  33. Boszotta H. Implant-free replacement of the anterior cruciate ligament with the double bundle technique: a modification of Passler’s operation technique. Unfallchirurg. 2010;113(7):549–54.

    Article  CAS  Google Scholar 

  34. Barie A, Kargus S, Huber J, Schmitt H, Streich NA. Anterior cruciate ligament reconstruction using quadriceps tendon autograft and press-fit fixation. Unfallchirurg. 2010;113(8):629–34.

    CAS  Google Scholar 

  35. Gobbi A, Diara A, Mahajan S, Zanazzo M, Tuy B. Patellar tendon anterior cruciate ligament reconstruction with conical press-fit femoral fixation: 5-year results in athletes population. Knee Surg Sports Traumatol Arthrosc. 2002;10(2):73–9.

    Article  Google Scholar 

  36. Felmet G. [ACL Reconstruction with the central third of the patellar ligament and simultanous proximal and distal press fit fixation, ALL PRESS FIT] In: AGA, editor. 14 Kongress der deutschsprachigen Arbeitsgemeinschaft für Arthroskopie AGA; October 3rd and 4th 1997 Berlin, 1997.

    Google Scholar 

  37. Felmet G. ALL-PRESS-FIT, a new surgical method with femoral and tibial press fit fixation. Arthroskopie. 1999;12:299–304.

    Article  Google Scholar 

  38. Felmet G. ACL reconstruction with proximal and distal press fit fixation (ALL PRESS FIT) with SDI (surgical diamond instrument) instruments. Osteosynthese Int. 2000;8:173–4.

    Google Scholar 

  39. Felmet G. [ALL PRESS FIT, a near the origin ACL reconstruction with demitendinosus and gracilis tendon, a new surgical technique] 21 Kongress der deutschsprachigen Arbeitsgemeinschaft für Arthroskopie (AGA); 1–2 October 2004, Lucerne, Switzerland. 2004.

    Google Scholar 

  40. Paessler HH, Mastrokalos DS. Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am. 2003;34(1):49–64.

    Article  Google Scholar 

  41. Liu YJ, Li ZL, Wang ZG, Wang Y, Zhou M, Wang AY, et al. The clinical application and biomechanical study of reconstruction of anterior and posterior cruciate ligament with hamstring tendons knot implant fixation. Zhonghua Wai Ke Za Zhi. 2005;43(4):239–42.

    Google Scholar 

  42. Al-Husseiny M, Batterjee K. Press-fit fixation in reconstruction of anterior cruciate ligament, using bone-patellar tendon-bone graft. Knee Surg Sports Traumatol Arthrosc. 2004;12(2):104–9.

    Article  Google Scholar 

  43. Biazzo A, Manzotti A, Motavalli K, Confalonieri N. Femoral press-fit fixation versus interference screw fixation in anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft: 20-year follow-up. J Clin Orthop Trauma. 2018;9(2):116–20.

    Article  CAS  Google Scholar 

  44. Forkel P, Petersen W. Anatomic reconstruction of the anterior cruciate ligament with the autologous quadriceps tendon. Primary and revision surgery. Oper Orthop Traumatol. 2014;26(1):30–42.

    Article  CAS  Google Scholar 

  45. Zink EJ, Trumper RV, Smidt CR, Rice EL, Reiser RF. Gender comparison of knee strength recovery following ACL reconstruction with contralateral patellar tendon graft. Biomed Sci Instrum. 2005;41:323–8.

    Google Scholar 

  46. Halder AM, Ludwig S, Neumann W. Arthroscopic anterior cruciate ligament reconstruction using the double press-fit technique: an alternative to interference screw fixation. Arthroscopy. 2002;18(9):974–82.

    Article  Google Scholar 

  47. Mauch F, Apic G, Becker U, Bauer G. Differences in the placement of the tibial tunnel during reconstruction of the anterior cruciate ligament with and without computer-assisted navigation. Am J Sports Med. 2007;35(11):1824–32.

    Article  Google Scholar 

  48. Klos TV, Habets RJ, Banks AZ, Banks SA, Devilee RJ, Cook FF. Computer assistance in arthroscopic anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 1998;354:65–9.

    Article  Google Scholar 

  49. Zaffagnini S, Klos TV, Bignozzi S. Computer-assisted anterior cruciate ligament reconstruction: an evidence-based approach of the first 15 years. Arthroscopy. 2010;26(4):546–54.

    Article  Google Scholar 

  50. Zaffagnini S, Urrizola F, Signorelli C, Grassi A, Di Sarsina TR, Lucidi GA, et al. Current use of navigation system in ACL surgery: a historical review. Knee Surg Sports Traumatol Arthrosc. 2016;24(11):3396–409.

    Article  CAS  Google Scholar 

  51. Felmet G. Anatomic double bundle single tunnel foreign material free ACL-reconstruction – a technical note. Muscles Ligaments Tendons J. 2011;1(4):148–52.

    Google Scholar 

  52. Felmet G. Foreign material-free ACL reconstruction with hollow miller: a biological and anatomic method for every ligament. Tech Orthop. 2013;28(2):166–75.

    Article  Google Scholar 

  53. Rupp S, Krauss PW, Fritsch EW. Fixation strength of a biodegradable interference screw and a press-fit technique in anterior cruciate ligament reconstruction with a BPTB graft. Arthroscopy. 1997;13(1):61–5.

    Article  CAS  Google Scholar 

  54. Seil R, Rupp S, Krauss PW, Benz A, Kohn DM. Comparison of initial fixation strength between biodegradable and metallic interference screws and a press-fit fixation technique in a porcine model. Am J Sports Med. 1998;26(6):815–9.

    Article  CAS  Google Scholar 

  55. Kuhne JH, Fottner M, Plitz W. Experimental stability of a new implant-free fixation technique in ACL replacement. Unfallchirurg. 1999;102(10):791–6.

    Article  CAS  Google Scholar 

  56. Mayr HO, Beck T, Hube R, Jager A, von Eisenhart-Rothe R, Bernstein A, et al. Axial load in case of press-fit fixation of the ACL graft – a fundamental study. Z Orthop Grenzgeb. 2005;143(5):556–60.

    Article  CAS  Google Scholar 

  57. Pavlik A, Hidas P, Czigany T, Berkes I. Biomechanical evaluation of press-fit femoral fixation technique in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2004;12(6):528–33.

    Article  Google Scholar 

  58. Boszotta H, Anderl W. Primary stability with tibial press-fit fixation of patellar ligament graft: an experimental study in ovine knees. Arthroscopy. 2001;17(9):963–70.

    Article  CAS  Google Scholar 

  59. Jagodzinski M, Scheunemann K, Knobloch K, Albrecht K, Krettek C, Hurschler C, et al. Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction. Knee Surg Sports Traumatol Arthrosc. 2006;14(12):1281–7.

    Article  CAS  Google Scholar 

  60. Ettinger M, Liodakis E, Haasper C, Hurschler C, Breitmeier D, Krettek C, et al. Tibial press-fit fixation of flexor tendons for reconstruction of the anterior cruciate ligament. Unfallchirurg. 2012;115(9):811–5.

    Article  CAS  Google Scholar 

  61. Ettinger M, Wehrhahn T, Petri M, Liodakis E, Olender G, Albrecht UV, et al. The fixation strength of tibial PCL press-fit reconstructions. Knee Surg Sports Traumatol Arthrosc. 2012;20(2):308–14.

    Article  CAS  Google Scholar 

  62. Felmet G. [ACL revision material free in a single step]. 25th annual meeting of GOTS; 18–20 June 2010; Munich, Germany. 2010.

    Google Scholar 

  63. Demyttenaere J, Claes S, Bellemans J. One-stage revision anterior cruciate ligament reconstruction in cases with excessive tunnel osteolysis. Results of a new technique using impaction bone grafting. Knee. 2018;25(6):1308–17.

    Article  Google Scholar 

  64. Pavlik A, Hidas P, Tallay A, Toman J, Berkes I. Femoral press-fit fixation technique in anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft: a prospective clinical evaluation of 285 patients. Am J Sports Med. 2006;34(2):220–5.

    Article  Google Scholar 

  65. Widuchowski W, Widuchowska M, Koczy B, Dragan S, Czamara A, Tomaszewski W, et al. Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up. BMC Musculoskelet Disord. 2012;13:115.

    Article  Google Scholar 

  66. Tomita F, Yasuda K, Mikami S, Sakai T, Yamazaki S, Tohyama H. Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction. Arthroscopy. 2001;17(5):461–76.

    Article  CAS  Google Scholar 

  67. Felmet G. In: Frenzel G, Wuschech H, editors. “Aquasprint” in the early functional rehabilitation program after ACL reconstruction. Berlin: Kongress Compact Verlag; 2002. p. 188–96.

    Google Scholar 

  68. Felmet G. [The significance of proprioceptive vibration training in postoperative treatment after ACL reconstruction]. DGOOC; 19.–24. October 2004; Berlin.

    Google Scholar 

  69. Krautter A, Rohnstock LM, Zhao Z, Felmet G. Instrumented arthrometry of the anterior cruciate ligament. A comparison. Biomed Tech. 2012;57:4299.

    Google Scholar 

  70. Runer A, et al. The evaluation of Rolimeter, KLT, KiRA and KT-1000 arthrometer in healthy individuals shows acceptable intra-rater but poor inter-rater reliability in the measurement of anterior tibial knee translation. Knee Surg Sports Traumatol Arthrosc. 2021.

    Google Scholar 

  71. Cameron M, Buchgraber A, Passler H, Vogt M, Thonar E, Fu F, et al. The natural history of the anterior cruciate ligament-deficient knee. Changes in synovial fluid cytokine and keratan sulfate concentrations. Am J Sports Med. 1997;25(6):751–4.

    Google Scholar 

  72. Jarvela T, Moisala AS, Sihvonen R, Jarvela S, Kannus P, Jarvinen M. Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med. 2008;36(2):290–7.

    Article  Google Scholar 

  73. Muneta T. Twenty-year experience of a double-bundle anterior cruciate ligament reconstruction. Clin Orthop Surg. 2015;7(2):143–51.

    Article  Google Scholar 

  74. Koivisto J, Kiljunen T, Kadesjo N, Shi XQ, Wolff J. Effective radiation dose of a MSCT, two CBCT and one conventional radiography device in the ankle region. J Foot Ankle Res. 2015;8:8.

    Article  Google Scholar 

  75. Koivisto J, Kiljunen T, Wolff J, Kortesniemi M. Assessment of effective radiation dose of an extremity CBCT, MSCT and conventional X-ray for knee area using MOSFET dosemeters. Radiat Prot Dosim. 2013;157(4):515–24.

    Article  CAS  Google Scholar 

  76. Koivisto J, van Eijnatten M, Kiljunen T, Shi XQ, Wolff J. Effective radiation dose in the wrist resulting from a radiographic device, two CBCT devices and one MSCT device: a comparative study. Radiat Prot Dosim. 2018;179(1):58–68.

    Article  Google Scholar 

  77. Pallaver A, Honigmann P. The role of cone-beam computed tomography (CBCT) scan for detection and follow-up of traumatic wrist pathologies. J Hand Surg Am. 2019;44(12):1081–7.

    Article  Google Scholar 

  78. Chmielnicki M, Siebert W, Prokop A. Foreign material-free anterior cruciate ligament repair with hamstring graft, Felmet technique. Z Orthop Unfall. 2018;156(2):223–5.

    Google Scholar 

  79. Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E. Anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med. 2019;47(14):3531–40.

    Article  Google Scholar 

  80. Siebold R, Schuhmacher P, Fernandez F, Śmigielski R, Fink C, Brehmer A, Kirsch J. Erratum to: Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site. Knee Surg Sports Traumatol Arthrosc. 2016;24(9):3046. https://doi.org/10.1007/s00167-014-3230-z. Erratum for: Knee Surg Sports Traumatol Arthrosc. 2015 Nov;23(11):3136–42. PMID: 25149644; PMCID: PMC6828258.

  81. Siebold R, Schuhmacher P, Fernandez F, Smigielski R, Fink C, Brehmer A, et al. Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3136–42.

    Article  Google Scholar 

  82. Smigielski R, Zdanowicz U, Drwiega M, Ciszek B, Ciszkowska-Lyson B, Siebold R. Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3143–50.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gernot Felmet .

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Felmet, G. (2022). History and Techniques of Material-Free and Press-Fit ACL Reconstruction. In: Press-Fit Fixation of the Knee Ligaments. Springer, Cham. https://doi.org/10.1007/978-3-031-11906-4_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-11906-4_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-11905-7

  • Online ISBN: 978-3-031-11906-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics