Effects of Tunnel Dilation and Interference Screw Position on the Biomechanical Properties of Tendon Graft Fixation for Anterior Cruciate Ligament Reconstruction

Higano, Masanori; Tachibana, Yomei; Sakaguchi, Katunobu; Goto, Tatsuru; Oda, Hiromi

doi:10.1016/j.arthro.2013.07.263

Cited by 14 publications

(10 citation statements)

References 23 publications

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“…However, the graft is at eccentric positions on the tibial and femoral tunnels in actual ACL reconstruction patients (Clancy et al, 1982; Higano et al, 2013). Therefore, this anatomic ACL reconstruction is not an actual center-center tunnel ACL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament reconstruction and cartilage contact forces—A 3D computational simulation

Wang

Lin

Fernandes

et al. 2015

Clinical Biomechanics

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Background Clinical outcome studies showed a high incidence of knee osteoarthritis after anterior cruciate ligament reconstruction. Abnormal joint kinematics and loading conditions were assumed as risking factors. However, little is known on cartilage contact forces after the surgery. Methods A validated computational model was used to simulate anatomic and transtibial single-bundle anterior cruciate ligament reconstructions. Two graft fixation angles (0° and 30°) were simulated for each reconstruction. Biomechanics of the knee was investigated in intact, anterior cruciate ligament deficient and reconstructed conditions when the knee was subjected to 134N anterior load and 400N quadriceps load at 0°, 30°, 60° and 90° of flexion. The tibial translation and rotation, graft forces, medial and lateral contact forces were calculated. Findings When the graft was fixed at 0°, the anatomic reconstruction resulted in slightly larger lateral contact force at 0° compared to the intact knee while the transtibial technique led to higher contact force at both 0° and 30° under the muscle load. When graft was fixed at 30°, the anatomic reconstruction overstrained the knee at 0° with larger contact forces, while the transtibial technique resulted in slightly larger contact forces at 30°. Interpretation This study suggests that neither the anatomic nor the transtibial reconstruction can consistently restore normal knee biomechanics at different flexion angles. The anatomic reconstruction may better restore anteroposterior stability and contact force with the graft fixed at 0°. The transtibial technique may better restore knee anteroposterior stability and articular contact force with the graft fixed at 30° of flexion.

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Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament reconstruction and cartilage contact forces—A 3D computational simulation

Wang

Lin

Fernandes

et al. 2015

Clinical Biomechanics

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“…9,51 Similar biomechanical experiments using porcine specimens have revealed no differences in maximum load-to-failure tests. 21,40 Differences in tunnel diameter, graft size, screw diameter, or screw materials may precipitate the discrepancy in these findings. 21 The aim of the present study was to assess the influence of different screw diameters while keeping the diameter of bone tunnel and tendon graft constant.…”

Section: Discussionmentioning

confidence: 99%

“…21,40 Differences in tunnel diameter, graft size, screw diameter, or screw materials may precipitate the discrepancy in these findings. 21 The aim of the present study was to assess the influence of different screw diameters while keeping the diameter of bone tunnel and tendon graft constant. Therefore, no tunnel dilatation was performed.…”

Section: Discussionmentioning

confidence: 99%

Significant Loss of ACL Graft Force With Tibial-Sided Soft Tissue Interference Screw Fixation Over 24 Hours: A Biomechanical Study

Kruppa

Flies

Wulsten

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Tibial-sided graft fixation is thought to be critical for the success of anterior cruciate ligament (ACL) reconstruction. Nevertheless, little is known about the graft force after fixation during the first 24 hours after surgery or the influence of screw diameter and length during this time. Purpose: To investigate the force, over the course of 24 hours, in soft tissue grafts secured with a tibial interference screw and to evaluate the effect of different screw diameters (7, 8, and 9 mm) and lengths (25 and 30 mm) on the force in these grafts. Study Design: Controlled laboratory study. Methods: Quadruple-strand flexor tendon grafts were fixed with bioabsorbable interference screws in 60 porcine tibiae. Grafts were pretensioned at 80 N over 10 minutes, and screws were inserted outside-in while a preload force of 80 N was applied. Different screw lengths (25 and 30 mm) and diameters (7, 8, and 9 mm), resulting in 6 groups with 10 specimens each, were tested. After release of the preload, graft force was recorded over 24 hours. Results: A significant decrease in graft force progressed in all groups over the 24-hour period. In total, a median loss of 75 N (IQR, 68-79 N) compared with the initial loading force was observed. Compared with the loading force of 80 N, this corresponded to a median loss of 91%. No significant differences in the remaining graft force could be found among the 6 different screw length and diameter groups after 10 minutes, 100 minutes, or 24 hours. Conclusion: Graft force in soft tissue grafts secured with a tibial interference screw decreased substantially over the first 24 hours after fixation. Neither the screw diameter nor the screw length affected the decrease in graft force. This raises substantial questions regarding the remaining fixation strength in vivo. Clinical Relevance: It should not be expected that ACL reconstruction can mechanically restabilize an injured knee as would an intact ACL. Reconstructed knees should be protected from mechanical overload in the early postoperative period.

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“… 7 Other studies evaluating tibial fixation also found similar values, using other methods of additional fixation. 20 , 21 …”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of a double fixation method for tendon graft in porcine tibia – using an interference screw plus staple

Bauer

Alberti

Corotti

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveThe aim of the study was to compare the mechanical behavior of interference screw tibial fixation vs. screw-plus-staple tibial fixation in an animal model.MethodsThirty-six pieces of swine knee specimens were selected and divided into two groups: Group 1, tibial fixation with interference screw (n = 17), and Group 2, fixation with interference screw and staple (n = 19). The models were submitted to a single cycle of tension testing. The following variables were measured: graft cross-sectional area, failure point on 10 mm (F10), yield load (Fy), and stiffness.ResultsThe mean values of graft cross-sectional area, F10, Fy, and stiffness did not present significant differences between the groups.ConclusionThe addition of a second staple-type ligament fixation device, complementing the interference screw, did not increase the mechanical safety of the system.

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Effects of Tunnel Dilation and Interference Screw Position on the Biomechanical Properties of Tendon Graft Fixation for Anterior Cruciate Ligament Reconstruction

Cited by 14 publications

References 23 publications

Anterior cruciate ligament reconstruction and cartilage contact forces—A 3D computational simulation

Anterior cruciate ligament reconstruction and cartilage contact forces—A 3D computational simulation

Significant Loss of ACL Graft Force With Tibial-Sided Soft Tissue Interference Screw Fixation Over 24 Hours: A Biomechanical Study

Biomechanical analysis of a double fixation method for tendon graft in porcine tibia – using an interference screw plus staple

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