A comparison of four tibial-fixation systems in hamstring-graft anterior ligament reconstruction

Abstract

The aim of this study was to evaluate at time-zero four tibial fixations on four major criteria: the elongation and cyclic stiffness of the hamstring graft construct under cyclic loading, the yield load and pullout stiffness under load at failure. Four fixation systems were tested: the Delta screw, the WasherLoc, the TightRope Reverse and the tape locking screw on 32 tibiae of adult pigs using 32 pairs of human semitendinosus and gracilis tendons. Two tests were performed: cyclic tests using loads at 70-220 N, to measure the elongation at the end of the cycles, followed by load-to-failure testing to measure the yield load and the cyclic stiffness. The mean elongation was 1.23 mm for the TLS, 3.81 mm for the Delta, 3.59 mm for the WasherLoc and 3.91 mm for the TightRope. The mean yield loads and SD were 1,015 ± 129 N for the TLS, 844 ± 394 N for the Delta, 511 ± 95 N for the WasherLoc and 567 ± 112 N for the TightRope. The results showed the significant superiority of TLS and Delta over WasherLoc and tibial TightRope in regard to yield load. The results showed the significant superiority of TLS over the other fixations in regard to slippage. The TLS system and the Delta screw provide a better quality of primary fixation to the tibia, but further in vitro studies are needed.

Can tape–screw fixation of a quadrupled semitendinosus graft in a full-length tibial tunnel provide superior fixation compared with a doubled semitendinosus–gracilis held with an interference screw? A matched-pair cadaveric biomechanical comparison

“…There were no statistically significant differences between the parameters measured for the two tibial fixation methods, however there were high standard deviations, a common observation in ACL fixation literature [ 14 , 21 , 23 , 29 ]. When failure due to 5 mm of relative displacement is considered as the critical parameter, these large variations resulted in insufficient samples to accurately determine the significance of the result.…”

“…One other issue of concern is the tendency of the Quad ST-tape construct to fail by elongation earlier than the ST-G construct. While the sample size was not sufficient to clearly determine which failure results were outliers, elongation as a material property of the braided 5-mm PET tape we utilized has been reported by other authors in situations other than ACL fixation [ 30 ], but not described in studies using wider 7-mm PET tape for ACL fixation [ 14 , 22 , 29 ]. Why the braided 7-mm PET tape does not reportedly suffer elongation, while the braided 5-mm PET tape does, remains uncertain.…”

“…The stability of the ST/G reconstruction also depends on the size and density of the tendons, with poor-quality tendons being more likely to deform plastically or slip past the screw [ 29 ]. It is possible that the early failure of a higher BMD specimen from the ST/G group was caused by such problems.…”

“…It is possible that the early failure of a higher BMD specimen from the ST/G group was caused by such problems. In contrast, the tensile strength of the Quad ST-tape construct depends on the compression of the tape to the screw–bone interface [ 14 , 22 , 29 ] and the added restriction of the knot holding the tape in place around that screw [ 23 ], but not tunnel friction. One difference between the two groups is with regards to how the measured parameters correlate with the BMD.…”

Injuries of the Sternoclavicular Joint - An Innovative Approach in the Management of a Rare Injury: Tight Rope Fixation of the Costo-Clavicular Ligament

“…However, very potent augmentation methods with non-resorbing filament bundles and bony anchoring by titanium platelets have recently been described. This technique for the anatomical augmentation of the coracoclavicular ligaments is also applied with great success for ACJ as wells as in the repair of the crucial ligaments at the knee and the syndesmosis at the ankle (26,27).…”