The Effect of Kurosaka Screw Divergence on the Holding Strength of Bone-Tendon-Bone Grafts

Pierz, Kristan; Baltz, Matthew S.; Fulkerson, John P.

doi:10.1177/036354659502300314

Cited by 107 publications

(55 citation statements)

References 7 publications

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“…Optimal interference fixation occurs when screws are placed parallel to the bone plug or soft-tissue graft, thus allowing maximal surface area contact between the screw and graft. Several laboratory studies indicate that screw divergence of 15°-30°dramatically decreases the fixation strength of the construct [32,52]. To prevent divergence, notching the anterior edge of the femoral tunnel before screw insertion, flexing the knee 100°-120°, and placing the screwdriver through the tibial tunnel may be helpful [50,53].…”

Section: Interference Screwsmentioning

confidence: 99%

RETRACTED ARTICLE: Graft fixation alternatives in anterior cruciate ligament reconstruction

Saccomanni¹

2011

Musculoskelet Surg

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Reconstruction of the anterior cruciate ligament is a frequently performed procedure that has had outstanding results. Outcomes are dependent upon an early postoperative physical therapy program that stresses early motion. Early rehabilitation demands rigid intraoperative mechanical fixation of the graft since therapy begins before biologic incorporation of the graft in the bone tunnels. Regardless of the graft substitute chosen, many methods of fixation are available. The best fixation technique depends on several factors, including graft choice and surgeon comfort. The figures are not documented in this paper. We review current methods available for graft fixation in anterior cruciate ligament surgery.

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Section: Interference Screwsmentioning

confidence: 99%

RETRACTED ARTICLE: Graft fixation alternatives in anterior cruciate ligament reconstruction

Saccomanni¹

2011

Musculoskelet Surg

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“…This reduces screw divergence and increases screw fixation strength. 43,44 The use of biodegradable interference screws offers several advantages over their metal analogues, such as undistorted magnetic resonance imaging, uncompromised revision surgery, and a reduced risk of graft laceration during screw insertion. [45][46][47][48][49] Soft threaded biodegradable interference screws (Sysorb) allow hamstring graft fixation close to the original PCL attachment site, which might increase the immediate postoperative posterior knee stability as was shown for ACL reconstruction 20,50,51 because the free graft length is reduced to its intra-articular portion.…”

Section: Discussionmentioning

confidence: 99%

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Stähelin

Südkamp

Weiler

2001

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Recent biomechanical studies have shown that an anatomic double-bundle posterior cruciate ligament (PCL) reconstruction is superior in restoring normal knee laxity compared with the conventional single-bundle isometric reconstruction. We describe a modification of an endoscopic PCL reconstruction technique using a double-bundle Y-shaped hamstring tendon graft. A double-or triple-bundle semitendinosus-gracilis tendon graft is used and directly fixed with soft threaded biodegradable interference screws. In the medial femoral condyle, 2 femoral tunnels are created inside-out through a low anterolateral arthroscopic portal. First, in 80°of flexion, the double-stranded gracilis graft is fixed with an interference screw inside the lower femoral socket, representing the insertion site of the posteromedial bundle. In full extension the combined semitendinosus-gracilis graft is pretensioned and fixed inside the posterior aspect of the single tibial tunnel. The double-or triple-stranded semitendinosus tendon is inserted in the higher femoral tunnel, presenting the insertion site of the anterolateral bundle. Finally, pretension is applied to the semitendinosus bundle in 70°of flexion and a third screw is inserted. Using this technique, the stronger semitendinosus part of the double-bundle graft, which mimics the anterolateral bundle of the PCL, is fixed in flexion, whereas the smaller gracilis tendon part (posteromedial bundle) is fixed in full extension. Thus, a fully arthroscopic anatomic PCL reconstruction technique is available that may better restore normal knee kinematics as compared to the single-stranded isometric reconstruction. Key Words: Posterior cruciate ligament-Double bundle-Biodegradable interference screw-Hamstring tendon.

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“…fixation strength of metallic interference screws, these implants have various disadvantages, such as distortion of magnetic resonance imaging (MRI), risk of graft laceration, and need for hardware removal [3,5,8,13,22,[26][27][28]. Bioabsorbable interference screws may offer advantages over metal interference screws.…”

mentioning

confidence: 99%

“…27]. In addition to the threat of bone plug breakage caused by a convergent running screw, one must be aware of diminished pull-out strength.…”

mentioning

confidence: 99%

Reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone graft with double biodegradable femoral pin fixation

Mahiroğulları

Yücel

Özkan³

2006

Knee Surg Sports Traumatol Arthr

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The purpose of this study was to evaluate the early clinical outcomes of the bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction using biodegradable cross pin fixation. The nature of this study is a prospective nonrandomized clinical outcome study. Thirty-five patients who underwent BPTB ACL reconstruction with a minimum of 2 years follow-up evaluation were included in the study. Thirty BPTB autografts and five BPTB allografts were fixed with two biodegradable 2.7 mm cross pins (Rigid Fix) on the femoral side. Clinical evaluation included International Knee Documentation Committee (IKDC), Lysholm and Tegner activity score, and Telos stress device measurements. The average Lysholm knee score was 94.7 (of 100). Twenty-four patients reported an excellent result. The other eight patients were in a good group. According to the IKDC scores, 23 (66%) patients reported normal function, 12 (34%) patients reported nearly normal function, and no (0%) patient reported abnormal or severely abnormal function. Telos stress device values were less than 3 mm of sagittal displacement in 28 patients and 5 mm in 7 patients. No patients complained that their knees gave way fully, even with moderate or strenuous activities. All of the patients have returned to their preinjury level of activity and athletic participation. Clinical results support this technique as a reliable alternative for patellar tendon fixation in ACL reconstruction.

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The Effect of Kurosaka Screw Divergence on the Holding Strength of Bone-Tendon-Bone Grafts

Cited by 107 publications

References 7 publications

RETRACTED ARTICLE: Graft fixation alternatives in anterior cruciate ligament reconstruction

RETRACTED ARTICLE: Graft fixation alternatives in anterior cruciate ligament reconstruction

Anatomic double-bundle posterior cruciate ligament reconstruction using hamstring tendons

Reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone graft with double biodegradable femoral pin fixation

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