scholarly journals Incorporation of Whipstitch Suture in Tibial Interference Fixation Improves Pullout in Anterior Cruciate Ligament Soft Tissue Grafts

2021 ◽  
Author(s):  
Ethan Bernstein ◽  
Kevin Taniguchi ◽  
Trevor Tompane ◽  
Hannah Kirby ◽  
Ryan Ponton ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibialis Anterior ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Interference Screw ◽  
Fixation Strength ◽  
Fixation Failure ◽  
Load To Failure ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

ABSTRACT Introduction Interference screw fixation of soft tissue grafts is commonly used in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to determine whether including suture material at the graft–screw interface affects ultimate fixation strength of soft tissue grafts using a tibialis anterior tendon allograft model. Materials and Methods Forty fresh-frozen human tibialis anterior tendon allografts were fixed to rigid polyurethane foam simulating the tibial tunnel. Twenty grafts underwent fixation with interference screws and 20 with interference bolts. Within each group, 10 grafts had suture in contact with either the screw or bolt. A load-to-failure test was then performed at a rate of 200 mm/min. Results The group of allografts with sutures in the tibial tunnel had significantly higher load to failure than the group without sutures. Using interference screw fixation, failure load of the grafts without sutures in the tunnel (535.2 ± 73.40 N) was significantly lower (P = .001) than with sutures in the tunnel (696.3 ± 110.0 N). Using interference bolt fixation, failure load of the grafts without sutures in the tunnel (613.0 ± 83.46 N) was significantly lower (P <.0001) than with sutures in the tunnel (845.8 ± 87.23 N). Conclusions In a biomechanical model, suture within the tibial tunnel enhances fixation strength with both interference screw and bolt fixation for soft tissue tibialis anterior allografts. Additionally, there was no difference in load to failure when comparing failure of a screw with suture in the tunnel with an interference bolt without suture. Due to improved biomechanical properties, incorporation of suture in the bone–graft interface should be considered when performing soft tissue ACL allograft reconstructions. Failure at the tibial bone–graft interface is a known complication of ACL reconstruction, and incorporation of suture within the interface should be considered for improved biomechanical properties.

scholarly journals Significant Loss of ACL Graft Force With Tibial-Sided Soft Tissue Interference Screw Fixation Over 24 Hours: A Biomechanical Study

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712091643
Author(s):  
Philipp Kruppa ◽  
Anne Flies ◽  
Dag Wulsten ◽  
Robert Collette ◽  
Georg N. Duda ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Fixation Strength ◽  
Screw Length ◽  
Screw Diameter ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

Background: Tibial-sided graft fixation is thought to be critical for the success of anterior cruciate ligament (ACL) reconstruction. Nevertheless, little is known about the graft force after fixation during the first 24 hours after surgery or the influence of screw diameter and length during this time. Purpose: To investigate the force, over the course of 24 hours, in soft tissue grafts secured with a tibial interference screw and to evaluate the effect of different screw diameters (7, 8, and 9 mm) and lengths (25 and 30 mm) on the force in these grafts. Study Design: Controlled laboratory study. Methods: Quadruple-strand flexor tendon grafts were fixed with bioabsorbable interference screws in 60 porcine tibiae. Grafts were pretensioned at 80 N over 10 minutes, and screws were inserted outside-in while a preload force of 80 N was applied. Different screw lengths (25 and 30 mm) and diameters (7, 8, and 9 mm), resulting in 6 groups with 10 specimens each, were tested. After release of the preload, graft force was recorded over 24 hours. Results: A significant decrease in graft force progressed in all groups over the 24-hour period. In total, a median loss of 75 N (IQR, 68-79 N) compared with the initial loading force was observed. Compared with the loading force of 80 N, this corresponded to a median loss of 91%. No significant differences in the remaining graft force could be found among the 6 different screw length and diameter groups after 10 minutes, 100 minutes, or 24 hours. Conclusion: Graft force in soft tissue grafts secured with a tibial interference screw decreased substantially over the first 24 hours after fixation. Neither the screw diameter nor the screw length affected the decrease in graft force. This raises substantial questions regarding the remaining fixation strength in vivo. Clinical Relevance: It should not be expected that ACL reconstruction can mechanically restabilize an injured knee as would an intact ACL. Reconstructed knees should be protected from mechanical overload in the early postoperative period.

A Biomechanical Comparison of Initial Fixation Strength of 3 Different Methods of Anterior Cruciate Ligament Soft Tissue Graft Tibial Fixation

2007 ◽  
Vol 35 (6) ◽  
pp. 949-954 ◽  
Author(s):  
Reed L. Bartz ◽  
Kory Mossoni ◽  
Jeffrey Tyber ◽  
John Tokish ◽  
Kenneth Gall ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Soft Tissue ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Interference Screws ◽  
Bioabsorbable Interference Screw ◽  
Load To Failure ◽  
Anterior Cruciate ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

Background Tibial fixation of soft tissue grafts continues to be problematic in the early postoperative period after anterior cruciate ligament reconstruction. Hypothesis No differences exist for resistance to slippage of soft tissue grafts fixed with CentraLoc, Intrafix, or 35-mm bioabsorbable interference screws. Study Design Controlled laboratory study. Methods Bovine tibia and hoof extensor tendons were divided into 3 matched groups with 12 tibia and 12 extensor tendons in each group. Within each group, 6 specimens underwent monotonic loading to failure (1 mm/s), and 6 underwent cyclic loading (10 000 cycles, 125-325 N, 1 Hz). Results No statistically significant differences were noted in mean load to failure or stiffness. The mean load to failure (and stiffness) for the 3 types of fixation were as follows: bioabsorbable interference screw, 631.6 ± 130.1 N (88.17 ± 6.79 N/mm); Intrafix, 644.3 ± 195.2 N (81.65 ± 16.5 N/mm); and CentraLoc, 791.1 ± 72.7 N (77.89 ± 7.07 N/mm). The slippage rates under cyclic loading for the 3 types of fixation were bioabsorbable interference screw, 0.336 ± 0.074 µm/cycle; Intrafix, 27.2 ± 31.6 µm/cycle; and CentraLoc, 0.0355 ± 0.0046 µm/cycle. In this model, CentraLoc proved statistically superior in resistance to cyclic loading compared with the bioabsorbable interference screw (P < .05) and Intrafix (P < .0001). The bioabsorbable interference screw proved statistically superior to Intrafix in resistance to cyclic loading (P < .05). Conclusions In this bovine model, CentraLoc and bioabsorbable interference screws provided superior resistance to cyclic loading compared with Intrafix. Clinical Relevance CentraLoc and bioabsorbable interference screws showed superior resistance to cyclic loading, which may indicate an increased resistance to clinical failure.

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