Bone-Patellar Tendon-Bone Grafts for Anterior Cruciate Ligament Reconstruction

Honl, M.; Carrero, Volker; Hille, E.; Schneider, Erich; Morlock, Michael M.

doi:10.1177/03635465020300041501

Cited by 43 publications

(16 citation statements)

References 53 publications

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“…The grafts were then immediately subjected to cyclic loading, under repeated loads, for 500 cycles between 50 and 250 N at a frequency of 1 Hz. The frequency of 1 Hz simulated the reported frequency of walking and an early postoperative rehabilitation protocol [13]. Immediately after cyclic testing was completed, the grafts were further displaced at 20 mm per minute until failure, and the mechanism of failure was subsequently noted.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button

Wijdicks

Brand

Nuckley

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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Current fixation techniques in medial knee reconstructions predominantly utilize interference screws alone for soft tissue graft fixation. The use of concurrent fixation techniques as part of a hybrid fixation technique has also been suggested to strengthen soft tissue fixation, although these hybrid fixation techniques have not been biomechanically validated. The purpose was to biomechanically evaluate two distal tibial superficial MCL graft fixation techniques that consisted of an interference screw alone and in combination with a cortical button. Furthermore, the aim was to compare interference screws of different constructs. Twenty-four porcine tibias (average bone mineral density of 1.3 ± 0.2 g/cm(2); range, 1.0-1.6 g/cm(2), measured by DEXA scan) were divided into 4 groups of six specimens each. Group Ia consisted of a 7 × 23-mm poly-L-lactide (PLLA) interference screw. Group Ib utilized a PLLA interference screw in combination with a cortical button. Group IIa consisted of a 7 × 23-mm composite 70% poly(L-lactide-co-D, L-lactide) and 30% biphasic calcium phosphate (BCP) interference screw. Group IIb also utilized a composite interference screw in combination with a cortical button. The specimens were biomechanically tested with cyclic (500 cycles, 50-250 N, 1 Hz) and load-to-failure (20 mm/min) parameters. During cyclic loading, a significant increase in stiffness was seen for the PLLA hybrid 29.6 (±6.9) N/mm fixation compared to the PLLA screw-only 21.2 (±3.8) N/mm group (P < 0.05). Failure loads were 407.8 (±77.9) N for the composite screw, 445 (±72.2) N for the PLLA screw-only, 473.9 (±69.6) N for the composite hybrid fixation, and 511.0 (±78.5) N for the PLLA hybrid fixation. The PLLA screw alone was found to provide adequate fixation for a superficial MCL reconstruction, and the use of a cortical suture button combined with the PLLA screw resulted in a stiffer fixation during cyclic loading. The current reconstruction superficial MCL graft fixation technique utilizing a PLLA interference screw alone serves as an adequate recreation of the native tibial superficial MCL strength. In addition, a hybrid fixation with a cortical button which lends additional cyclic stiffness to its fixation would be advisable for use in suboptimal fixation cases.

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Section: Methodsmentioning

confidence: 99%

Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button

Wijdicks

Brand

Nuckley

et al. 2010

Knee Surg Sports Traumatol Arthrosc

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show abstract

“…Then the free ends of the suture are passed through the loop (b) followed by a subsequent loop going through the inside of the previous wrap (c). Finally, the knot is pulled tight and the wraps are neatened up (d) mode for ACL fixation devices [8,10,16,18,21]. While loading the specimens, the displacements and forces were recorded with a sampling rate of 10 Hz.…”

Section: Methodsmentioning

confidence: 99%

“…The resulting length was defined as Δ L = 0. A tensile load was applied at a constant displacement rate of 1 mm/s, which is a standard testing mode for ACL fixation devices [8, 10, 16, 18, 21]. While loading the specimens, the displacements and forces were recorded with a sampling rate of 10 Hz.…”

Section: Methodsmentioning

confidence: 99%

Modified Prusik knot versus whipstitch technique for soft tissue fixation in anterior cruciate ligament reconstruction: a biomechanical analysis

Krappinger

Kralinger

Attal

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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Appropriate graft tension and secure graft incorporation in bone tunnels are essential for successful anterior cruciate ligament (ACL) reconstruction using hamstring tendon autografts. Permanent viscoplastic elongation in response to cyclic loading in the early postoperative period and the interposition of suture material in the tendon-bone interface might negatively affect graft function and rigid graft incorporation in the bone tunnels. A modified Prusik knot is an alternative option to the commonly used whipstitch technique for soft tissue fixation in ACL reconstruction. This is a controlled laboratory study. Sixteen formalin-fixed human cadaver semitendinosus tendons were armed with a modified Prusik knot or a whipstitch and tested in a load-to-failure test with a constant displacement rate of 1 mm/s, 14 in the cyclic loading test with 100 cycles from 10 to 50 N followed by 100 cycles from 10 to 75 N. The modified Prusik knot showed smaller force-induced displacements and higher stiffness of the entire construct in the load-to-failure test. Smaller preconditioning displacements were the only significant differences in the cyclic loading test. The modified Prusik knot has equal or superior mechanical properties and provides a larger area in the tendon-bone interface without suture material compared with the whipstitch technique.

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“…After the cyclic loading, the load was again held at 50 N or 100 N for 60 s and then a final ramp displacement until failure at 0.5 mm/s was applied. In all cyclic tests, a 1 Hz load frequency was used to reproduce normal walking frequency [16].…”

Section: Methodsmentioning

confidence: 99%

“…This testing simulated an aggressive, but typical, rehabilitation protocol after an ACL reconstruction [19]. The 300 N load is the upper force expected during normal daily activities, so cyclic testing up to 300 N simulated peaks occurring postoperatively [16]. The 5000 cycles represented an extreme test of the free graft fixation stability [20].…”

Section: Methodsmentioning

confidence: 99%

Does thread shape affect the fixation strength of the bioabsorbable interference screws for anterior cruciate ligament reconstructions? A biomechanical study

Garcés¹,

Fuentes²,

Yáñez³

et al. 2019

BMC Musculoskelet Disord

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BackgroundThe purpose of this study was to compare the biomechanical behaviour of two bioabsorbable interference screws with different geometries.MethodsTwo different pitch (2.5 and 5 mm) bioabsorbable interference screws, both 9 × 30 mm, were tested. Tests were performed with forty bovine digital extensor tendons and skeletally mature porcine tibiae. Two protocols of cyclic tests at 1 Hz were performed: 1000 cycles from 50 to 250 N, and 5000 cycles from 100 to 300 N (n = 10 for each type of test and screw). After the cyclic loading, a final ramp displacement until failure at 0.5 mm/s was applied.ResultsThe stiffness after the cyclic phase of the tests was not statistically different between the two screws (1000th cycle: 2.5 mm pitch 280.3 ± 56.4 N/mm, 5 mm pitch 275.2 ± 65.0 N/mm, P = .965; 5000th cycle: 2.5 mm pitch 281.3 ± 66.4 N/mm, 5 mm pitch 286.1 ± 79.4 N/mm, P = .814). The yield load was not significantly different between the screws (1000 cycle tests: 2.5 mm pitch 482.2 ± 120.2 N, 5 mm pitch 495.9 ± 131.3 N, P = .508; 5000 cycle tests: 2.5 mm pitch 476.4 ± 65.3 N, 5 mm pitch 494.3 ± 39.2 N, P = .391). No correlation was found between the insertion torque and yield load (1000 cycle tests, R2 = 0.013; 5000 cycle tests, R2 = 0.006).ConclusionsThe pitch of bioabsorbable interference screws does not seem to affect fixation strength. Also, the authors recommend not to use insertion torque alone to estimate the fixation strength.

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Bone-Patellar Tendon-Bone Grafts for Anterior Cruciate Ligament Reconstruction

Abstract: Results of testing are useful to the surgeon in making a choice of reconstruction technique.

Cited by 43 publications

References 53 publications

Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button

Biomechanical evaluation of a medial knee reconstruction with comparison of bioabsorbable interference screw constructs and optimization with a cortical button

Modified Prusik knot versus whipstitch technique for soft tissue fixation in anterior cruciate ligament reconstruction: a biomechanical analysis

Does thread shape affect the fixation strength of the bioabsorbable interference screws for anterior cruciate ligament reconstructions? A biomechanical study

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