Investigation of a hybrid method of soft tissue graft fixation for anterior cruciate ligament reconstruction

Is Supplementary Fixation Necessary in Anterior Cruciate Ligament Reconstructions?

“…In the Hammond et al study, the authors were able to place the second-line fixation first (closed loop and button) followed by the first line of fixation (interference screw), which would help create tension for the 2 fixations equally and, as Hammond et al 8 stated, allow the polyester loop to function as an anchor at the tip of the screw. In contrast, Au et al 1 reported that the hybrid fixation of an EndoButton and an interference screw was not a load-sharing construct. They reported an increase in ultimate load but not stiffness.…”

Graft healing in anterior cruciate ligament reconstruction

“…Although there are a large number of publications exploring differences in biomechanical properties between different fixation devices at time 0 [10,14,43,45,57,58,122,130], comparative studies exploring differences in biological incorporation of soft-tissue grafts between different fixation methods are lacking [96,131].…”

Biomechanical Analysis of Femoral Tunnel Pull-out Angles for Anterior Cruciate Ligament Reconstruction with Bioabsorbable and Metal Interference Screws

“…Authors of previous biomechanical studies of ACL graft fixation with interference screws examined construct stability by pulling in line with the bone tunnel. 1,2,9 Pavlik et al 27 described the effects of altering pull angle of bone–patellar tendon grafts in porcine femurs to evaluate the press-fit fixation technique. Significant differences in failure strength and stiffness between pulls at 0°, 15°, 30°, and 45° relative to the bone tunnel were reported.…”

“…6,13,14,18,19 To evaluate the strength and stability of ACL fixation with various fixation devices and techniques, previous authors evaluated the pull-out strength of the soft tissue graft at the femoral tunnel and tibial tunnel attachments. 1,2,9 In these studies, the angle of pull relative to the femoral tunnel was usually set directly in line with the bone tunnel, a condition that is only achieved in vivo with the knee in hyperflexion. 1,2,6,7,9,15,32 However, in clinical practice, evaluation of the ACL reconstruction is conducted with tests (such as the Lachman and the anterior drawer) that assess strength and stability at various knee flexion angles.…”

“…1,2,9 In these studies, the angle of pull relative to the femoral tunnel was usually set directly in line with the bone tunnel, a condition that is only achieved in vivo with the knee in hyperflexion. 1,2,6,7,9,15,32 However, in clinical practice, evaluation of the ACL reconstruction is conducted with tests (such as the Lachman and the anterior drawer) that assess strength and stability at various knee flexion angles. 16,31 In addition, the rehabilitation process is conducted Background: Fixation strength of metal and bioabsorbable interference screws has not been evaluated while varying the anterior cruciate ligament graft tension angle.…”