Femoral Press-Fit Fixation of the Hamstring Tendons for Anterior Cruciate Ligament Reconstruction

Jagodzinski, Michael; Behfar, V.; Hurschler, Christof; Albrecht, K.; Krettek, Christian; Bösch, U.

doi:10.1177/0363546503262692

Cited by 19 publications

(31 citation statements)

References 29 publications

(57 reference statements)

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“…The strain rate used in this study (1 mm/s) has been used in most recent investigations [9,16,26,31] and makes the results comparable with our previous investigation [13].…”

Section: Discussionsupporting

confidence: 79%

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Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction

Jagodzinski

Scheunemann

Knobloch

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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Press-fit fixation of patellar tendon bone anterior cruciate ligament autografts is an interesting technique because no hardware is necessary to achieve fixation. Up till the present point, there is no biomechanical data available for the tibial press-fit fixation of the hamstring tendons. Hamstring tendons of 21 human cadavers (age: 41.9 +/- 13.1 years) were used. A press-fit fixation with looped semitendinosus and gracilis tendons secured by a tape (T) over a bone bridge, or by a baseball-stitched suture (S), was compared with degradable interference screw fixation (I) in 21 porcine tibiae. The constructs were cyclically strained and subsequently loaded to failure. The maximum load to failure, stiffness, and elongation during cyclical loading were measured. The maximum load to failure was highest for the T-fixation at 970 +/- 83 N, followed by the I-fixation with 544 +/- 109 N, and the S-fixation with 402 +/- 78 N (P < 0.03). Stiffness of the constructs averaged 78 +/- 13 N/mm for T, 108 +/- 18 N/mm for S, and 162 +/- 27 N/mm for I (P < 0.03). Elongation during initial cyclical loading was 2.0 +/- 0.6 mm for T, 3.3 +/- 1.1 mm for S, and 1.4 +/- 0.5 mm for I (S inferior to I and T, P<0.05). Elongation between the 20th and 1,500th loading cycle was lower for T (2.2 +/- 0.7 mm) compared with I (4.1 +/- 2.7 mm) and S (4.8 +/- 0.7 mm; P < 0.001). The T-fixation technique exhibited a significantly higher failure load than the S-, and I- techniques. All techniques exhibited larger elongation during initial cyclical loading than is reported in the literature for grafts with bone blocks. Only one technique (T) showed satisfactory elongation behavior during long-term cyclic loading. Interference screw fixation demonstrated significantly higher stiffness. Only one of the investigated techniques (T) seemed to exhibit adequate mechanical properties necessary for early aggressive rehabilitation programs.

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“…The strain rate used in this study (1 mm/s) has been used in most recent investigations [9,16,26,31] and makes the results comparable with our previous investigation [13].…”

Section: Discussionsupporting

confidence: 79%

“…In contrast to our previous investigation [13], we added a long-term test (1,500 cycles) to our protocol. The results suggest that fixation forces are not adequate for both interference screw and suture fixation (4.1 ± 2.7 and 4.8 ± 0.7 mm).…”

Section: Discussionmentioning

confidence: 99%

Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction

Jagodzinski

Scheunemann

Knobloch

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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“…As is done clinically, the graft was fixed with an initial 89-N tensile force and held in place for twenty minutes. This level of force has been used in previous studies 6,7,22,23 . After preconditioning, the graft was immediately inserted into the knee, and femoral fixation was secured.…”

Section: Methodsmentioning

confidence: 99%

Effect of Different Preconditioning Protocols on Anterior Knee Laxity After ACL Reconstruction with Four Commonly Used Grafts

Boguszewski¹,

Joshi²,

Wang

et al. 2015

The Journal of Bone and Joint Surgery

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“…Thus, tensioning of the graft in extension does not displace the bone block in the femoral tunnel. 23 Finally, the procedure is technically demanding and should be carried out by experienced arthroscopic surgeons as an alternative to interference screw fixation. Oversizing the bone block by 2 mm results in a high degree of press-fit fixation strength and still allows insertion without fracture of the bone block.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic ACL Reconstruction in Press-Fit Technique

Halder¹,

Marx²

2013

Techniques in Orthopaedics

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Press-fit techniques for arthroscopic ACL replacement have been developed to avoid problems and complications related to the use of interference screws. Improper insertion of screws may reduce primary stability, injure the posterior femoral cortex, or displace hardware into the joint. Most techniques described use press-fit on either the femoral or tibial side. To avoid any supplemental fixation material an arthroscopic method was developed which achieves patellar tendon autograft fixation by press-fit on both sides. On the femoral side angling of the patellar bone block in relation to the direction of ligament tension increases pullout strength. On the tibial side the oversized bone block anchors with progressive strength in the cylindrical tibial tunnel creating an ideal environment for osseous integration. Concurrently, a stable fixation is achieved allowing early functional rehabilitation. However, fixation strength depends on bone quality and the arthroscopic procedure is demanding.

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Femoral Press-Fit Fixation of the Hamstring Tendons for Anterior Cruciate Ligament Reconstruction

Abstract: Two of the 3 hamstring press-fit fixation techniques showed loads to failure similar to the patellar tendon fixation. Preconditioning of the constructs is critical. These results must be interpreted with care because of high standard deviations.

Cited by 19 publications

References 29 publications

Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction

Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction

Effect of Different Preconditioning Protocols on Anterior Knee Laxity After ACL Reconstruction with Four Commonly Used Grafts

Arthroscopic ACL Reconstruction in Press-Fit Technique

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