Hamstring tendon fixation using interference screws: a biomechanical study in calf tibial bone

doi:10.1016/S0749-8063(98)70117-3

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 14, Issue 1, January–February 1998, Pages 29-37

https://doi.org/10.1016/S0749-8063(98)70117-3 Get rights and content

Abstract

It has recently been shown that graft fixation close to the ACL insertion site is optimal in order to increase anterior knee stability. Hamstring tendon fixation using interference screws offers this possibility and a round threaded titanium interference screw has been previously developed. The use of a round threaded biodegradable interference screw may be equivalent. In addition, to increase initial fixation strength, graft harvest with a distally attached bone plug may be advantageous, but biomechanical data do not exist. This study compares the initial pullout force, stiffness of fixation, and failure modes of three strand semitendinosus grafts in 36 proximal calf tibiae using either biodegradable poly-(D,L-lactide) (Sysorb; Sulzer Orthopaedics Ltd, Munsingen, Switzerland) or round threaded titanium (RCI; Smith & Nephew DonJoy, Carlsbad, CA) interference screws, harvested either without (biodegradable: group I, titanium III) or with (biodegradable: group II, titanium: group IV) attached tibial bone plugs. Maximum pullout force in group I (507 ± 93 N) was significantly higher than in group III (419 ± 77 N). Pullout force of bone plug fixation was significantly higher than that of direct tendon fixation (717 ± 90 N in group II and 602 ± 117 N in group IV). Pullout force of biodegradable fixation was significantly higher in both settings. These results indicate that initial pullout force of hamstring-tendon graft interference screw fixation can be increased by using a biodegradable interference screw. In addition, initial pullout force of hamstring-tendon graft fixation with an interference screw can be greatly increased by harvesting the graft with its distally attached tibial bone plug.

Arthroscopy 1998 Jan-Feb;14(1):29-37

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Citation Excerpt :
It may be clinically (but not statistically [P = .23]) significant that at final follow-up, 100% of knees showed normal IKDC knee examination ratings in the suspensory group versus 86% of knees in the aperture group. This finding seems important because the trend in all-inside ACL reconstruction is evolution from aperture18 to suspensory fixation,19-26 but the 2-year clinical outcome of all-inside ACL suspensory fixation has not been previously reported, so it is reassuring that the increasingly popular experimental technique (suspensory fixation) did not result in worse outcomes than the control technique (aperture fixation). This is not to imply that, at final follow-up, suspensory fixation scores were uniformly superior to aperture fixation scores; in fact, for some outcome measures (narcotic consumption, KSS pain score, IKDC subjective score, SF-12 physical and mental component scores, and 3 of 4 radiographic scores), aperture fixation showed superior scores, and critically, as noted earlier, there were no statistically significant differences between the groups for any of the outcomes measured.
To compare anterior cruciate ligament (ACL) soft-tissue allograft reconstruction using suspensory versus aperture fixation.
After we performed prospective power analysis and obtained institutional review board approval, as well as patient consent, 64 patients were block randomized among 3 study sites to the aperture fixation group or suspensory fixation group. All patients underwent all-inside ACL reconstruction with soft-tissue allograft using either (1) femoral and tibial joint-line fixation with a femoral cannulated interference screw and a tibial cannulated interference retrograde screw (aperture) or (2) femoral and tibial cortical buttons (suspensory). Our primary outcome measure was knee anteroposterior (AP) stability measured using the KT-1000 device (MEDmetric, San Diego, CA). Secondary outcome measures included change in pain score on a visual analog scale versus preoperatively, narcotic consumption, International Knee Documentation Committee knee examination rating, International Knee Documentation Committee subjective evaluation score, Knee Society Scores, Short Form 12 scores, and radiographic analysis for socket widening.
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