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

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/cm²; range, 1.0–1.6 g/cm², 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.