A Single Cycle Study of Screw Fixation in Anterior Cruciate Ligament Reconstruction

2008 ◽  
Author(s):  
M. Chizari ◽  
B. Wang ◽  
M. Snow
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Anatomical Reconstruction ◽  
Initial Stability ◽  
History Of ◽  
Post Traumatic ◽  
Anterior Cruciate

The natural history of Anterior Cruciate rupture is one of progressive deterioration of knee function, with the development of instability, meniscal tears and post traumatic osteoarthritis. The current surgical approach is for anatomical reconstruction using a biological tissue autograft. It is well understood that the initial stability is dependent on the strength of the fixation rather than the strength of the graft, until the graft becomes biologically incorporated in the bone tunnel. A study was carried out to better understand postoperative internal bone stresses in anterior cruciate ligament (ACL) reconstruction surgery. The mechanical aspects of an interface screw fixation were examined both experimentally and numerically, with the aim to minimize deleterious effects in ACL reconstruction. The tibial cortical/cancellous bony tunnel and the stress pattern resulting from the screw fixation in the tunnel are investigated.

scholarly journals Can the body slope of interference screw affect initial stability of reconstructed anterior cruciate ligament?: An in-vitro investigation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nazanin Daneshvarhashjin ◽  
Mahmoud Chizari ◽  
Javad Mortazavi ◽  
Gholamreza Rouhi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Reconstruction Process ◽  
Interference Screws ◽  
Bone Screw ◽  
Initial Stability ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Abstract Background Superior biomechanical performance of tapered interference screws, compared with non-tapered screws, with reference to the anterior cruciate ligament (ACL) reconstruction process, has been reported in the literature. However, the effect of tapered interference screw’s body slope on the initial stability of ACL is poorly understood. Thus, the main goal of this study was to investigate the effect of the interference screw’s body slope on the initial stability of the reconstructed ACL. Methods Based on the best screw-bone tunnel diameter ratios in non-tapered screws, two different tapered interference screws were designed and fabricated. The diameters of both screws were equal to bone tunnel diameter in one-third of their length from screw tip, then they were gradually increased by 1mm, in the lower slope (LSTIS), and 2 mm, in the higher slope (HSTIS) screws. To simulate the ACL reconstruction, sixteen soft tissue grafts were fixed, using HSTIS and LSTIS, in synthetic bone blocks. Through applying sub-failure cyclic incremental tensile load, graft-bone-screw construct’s stiffness and graft laxity in each cycle, also through applying subsequent step of loading graft to the failure, maximum load to failure, and graft’s mode of failure were determined. Accordingly, the performance of the fabricated interference screws was compared with each other. Results HSTIS provides a greater graft-bone-screw construct stiffness, and a lower graft laxity, compared to LSTIS. Moreover, transverse rupture of graft fibers for LSTIS, and necking of graft in the HSTIS group were the major types of grafts’ failure. Conclusions HSTIS better replicates the intact ACL’s behavior, compared to LSTIS, by causing less damage in graft’s fibers; reducing graft laxity; and increasing fixation stability. Nonetheless, finding the optimal slope remains as an unknown and can be the subject of future studies.

scholarly journals The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction

2018 ◽  
Vol 7 (5) ◽  
pp. 327-335 ◽  
Author(s):  
Y. Sato ◽  
R. Akagi ◽  
Y. Akatsu ◽  
Y. Matsuura ◽  
S. Takahashi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Acl Reconstruction ◽  
Bone Healing ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Femoral Bone ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Objectives To compare the effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament (ACL) reconstruction animal model. Methods Anterior cruciate ligament reconstruction using the plantaris tendon as graft material was performed on both knees of 24 rabbits (48 knees) to mimic ACL reconstruction by two different suspensory fixation devices for graft fixation. For the adjustable fixation device model (Socket group; group S), a 5 mm deep socket was created in the lateral femoral condyle (LFC) of the right knee. For the fixed-loop model (Tunnel group; group T), a femoral tunnel penetrating the LFC was created in the left knee. Animals were sacrificed at four and eight weeks after surgery for histological evaluation and biomechanical testing. Results Histologically, both groups showed a mixture of direct and indirect healing patterns at four weeks, whereas only indirect healing patterns were observed in both groups at eight weeks. No significant histological differences were seen between the two groups at four and eight weeks in the roof zone (four weeks, S: mean 4.8 sd 1.7, T: mean 4.5 sd 0.5, p = 0.14; eight weeks, S: mean 5.8 sd 0.8, T: mean 4.8 sd 1.8, p = 0.88, Mann-Whitney U test) or side zone (four weeks, S: mean 5.0 sd 1.2, T: mean 4.8 sd 0.4, p = 0.43; eight weeks, S: mean 5.3 sd 0.8,T: mean 5.5 sd 0.8, p = 0.61, Mann-Whitney U test) . Similarly, no significant difference was seen in the maximum failure load between group S and group T at four (15.6 sd 9.0N and 13.1 sd 5.6N) or eight weeks (12.6 sd 3.6N and 17.1 sd 6.4N, respectively). Conclusion Regardless of bone tunnel configuration, tendon-bone healing after ACL reconstruction primarily occurred through indirect healing. No significant histological or mechanical differences were observed between adjustable and fixed-loop femoral cortical suspension methods. Cite this article: Y. Sato, R. Akagi, Y. Akatsu, Y. Matsuura, S. Takahashi, S. Yamaguchi, T. Enomoto, R. Nakagawa, H. Hoshi, T. Sasaki, S. Kimura, Y. Ogawa, A. Sadamasu, S. Ohtori, T. Sasho. The effect of femoral bone tunnel configuration on tendon-bone healing in an anterior cruciate ligament reconstruction: An animal study. Bone Joint Res 2018;7:327–335. DOI: 10.1302/2046-3758.75.BJR-2017-0238.R2.

scholarly journals A study on functional outcome of arthroscopic anatomical reconstruction of anterior cruciate ligament using quadrupled hamstring graft

2017 ◽  
Vol 3 (4) ◽  
pp. 854
Author(s):  
Jagdeesh P. C. ◽  
Suhail R. Shaikh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Functional Outcome ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Scoring Systems ◽  
Activity Level ◽  
Anatomical Reconstruction ◽  
Proper Patient Selection ◽  
Anterior Cruciate ◽  
Hamstrings Tendon

<p class="abstract"><strong>Background:</strong> Various techniques and graft types are now available for the reconstruction of ACL. Opinions differ among experts with regard to the ideal technique and graft type to be used. Arthroscopic anatomical ACL reconstruction using quadrupled hamstring autograft with fixation in the femoral tunnel using tightrope and in the tibial tunnel with interference screw is a relatively new technique. Purpose of this study is to analyze the postoperative outcome in our experience with this procedure.</p><p class="abstract"><strong>Methods:</strong> This was a prospective study of patients with ACL injury who underwent Arthroscopic anatomical ACL reconstruction using quadrupled hamstrings autograft. All patients were operated upon by the same surgeon and had the same rehabilitation protocol. They were followed up for six months at regular intervals using IKDC, LGS scoring systems, tegner activity scale and a subjective questionnaire.<strong></strong></p><p class="abstract"><strong>Results:</strong> About 95% of the patients had a favorable outcome as per three scoring systems. (IKDC, Lysholm score, subjective questionnaire) all three scoring system had a very high correlation around 90% of individuals were able to return to their pre injury activity level.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that the functional outcome of arthroscopic anatomical anterior cruciate ligament reconstruction using quadrupled hamstrings tendon autograft is excellent to good (95%). With proper patient selection and rehabilitation full occupational and recreational activities can be expected for most of the patients within four to six months of the procedure.</p>

scholarly journals Can the Body Slope of Interference Screw Affect Initial Stability of Reconstructed Anterior Cruciate Ligament?: In-vitro Investigation

2021 ◽  
Author(s):  
Nazanin Daneshvarhashjin ◽  
Mahmoud Chizari ◽  
SM Javad Mortazavi ◽  
Gholamreza Rouhi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Bone Tunnel ◽  
Interference Screws ◽  
Bone Screw ◽  
Initial Stability ◽  
In Vitro Investigation ◽  
Tunnel Diameter ◽  
Anterior Cruciate

Abstract Background Superior biomechanical performance of tapered interference screws, in regard to reconstruction of anterior cruciate ligament (ACL), compared with non-tapered screws, has been reported in the literature. However, the effect of tapered interference screw’s body slope on the initial stability of ACL is not studied yet. Thus, the main goal of this study was to investigate the effects of interference screw's body slope on the initial stability of the reconstructed ACL. Methods Based on the best screw-bone tunnel diameter ratios in non-tapered screws, two different tapered interference screw were designed and fabricated. The diameters of both screws were considered to be equal to bone tunnel diameter in one third of their length from screw tip, then they were gradually increased by 1mm, in the lower slope (LSTIS), and 2 mm, in the higher slope (HSTIS) screws. To simulate the ACL reconstruction, sixteen soft tissue grafts were fixed, using HSTIS and LSTIS, in synthetic bone blocks. Through applying sub-failure cyclic incremental tensile load, graft-bone-screw construct's stiffness and graft laxity in each cycle, and through applying subsequent step of loading graft to the failure, maximum load to failure, and graft’s mode of failure were determined. Accordingly, performance of the fabricated interference screws were compared with each other. Results HSTIS, compared to LSTIS, provides a greater graft-bone-screw construct stiffness, and a lower graft laxity. Moreover, transverse rupture of graft fibers for LSTIS, and necking of graft in HSTIS group were the major types of grafts' failure. ConclusionHSTIS compared to LSTIS, by causing less damage in graft's fibers; reducing graft laxity; and increasing fixation stability, better replicates the intact ACL's behavior.

Plyometrics Did Not Improve Jump-Landing Biomechanics in Individuals With a History of Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial

2021 ◽  
pp. 1-8
Author(s):  
Hyunjae Jeon ◽  
Sean Krysak ◽  
Steven J. Pfeiffer ◽  
Abbey C. Thomas
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Body Mass ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Jump Landing ◽  
History Of ◽  
Anterior Cruciate

Second anterior cruciate ligament (ACL) injury has similar biomechanical risk factors as primary injury. Standard of care rehabilitation does not adequately mitigate these biomechanical risks. This study examined the effectiveness of a 4-week plyometric intervention on biomechanical risk factors of second ACL injury versus no intervention in patients with a history of ACL reconstruction. Thirty adults post-ACL reconstruction received 12 sessions of plyometric (age: 19.9 ± 1.62 years; body mass index: 23.9 ± 2.6 kg/m2; months postoperative: 35.7 ± 24.2) or no (age: 21.3 ± 3.5 years; body mass index: 27.7 ± 4.8 kg/m2; months postoperative: 45.3 ± 25.4) exercise intervention. Hip and knee biomechanics were quantified during a jump-landing task before and after the intervention. Individual response to the intervention was evaluated via minimal detectable change. Hip flexion angle had the greatest response to plyometric training. Overall, focused plyometric intervention did not adequately mitigate biomechanical risk factors of second ACL injury; thus, development of interventions capable of modifying biomechanics known to contribute to ACL injury risk remains necessary.

scholarly journals Simultaneous Double-boundle “All Inside” Posterior Cruciate Ligament and Anterior Cruciate Ligament Reconstruction: 2 Years Follow Up

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0018
Author(s):  
Franco Farina ◽  
Matías Orlando ◽  
Ma. Florencia Weisburd ◽  
Francisco Vega ◽  
Emilio Morales ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Posterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anatomical Reconstruction ◽  
Pcl Reconstruction ◽  
Kt 1000 ◽  
Anterior Cruciate ◽  
Anterior Posterior

The purpose of this study was to evaluate the clinical results of simultaneuos Double-boundle “All Inside” posterior Cruciate Ligament (PCL) and Anterior Cruciate Ligament (ACL) Reconstruction. Methods: this study population included 31 men and 2 women with 26 acute and 7 chronic knee injuries. Ligament injuries included 21 ACL / PCL / Posterolateral instability, 9 ACL / PCL / Medial Cruciate Ligament (MCL), 3 ACL / PCL instability. Artroscopically assited combined ACL/PCL. Reconstruction were performed using the All Inside PCL reconstruction and ACL anatomical Reconstruction. The patients were followed up for a minimum of 2 years and evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm Rating scale. The anterior-posterior knee laxity was assessed by KT-1000 examination. Results: At the last Follow Up, all patients showed normal knee extension. Two patients had 10 grades flexion limitation, and five had a 5 grades flexion limitation. The Lysholm scores was 90,4 +/- 4,6. According to the last IKDC evaluation, the results were graded as normal in 21 patients (63,6%), nearly normal in 11 patients (33,3%), and abnormal in 1 patient (3,1%). The KT-1000 examination showed that de side to side difference in overall anterior-posterior laxity at 70 grades flexion was 0 to 2 mm in 24 patients, 3 to 5 mm in 8 patients, and 6 to 10 mm in 1 patient; the side to side difference in overall anterior-posterior laxity at 20 grades flexion was 0 to 2 mm in 23 patients, 3 to 5 mm in 9 patients and 6 to 10 mm in 1 patient. Conclusion: simultaneuos Double-Boundle “All Inside” PCL and ACL reconstruction can effectively and safely restore knee stability, and can yield normal results in 62,5% of patients and nearly normal in 33,3% at minimum 2 years.

An Autograft for Anterior Cruciate Ligament Reconstruction Results in Better Biomechanical Performance and Tendon-Bone Incorporation Than Does a Hybrid Graft in a Rat Model

2020 ◽  
Vol 48 (14) ◽  
pp. 3515-3524
Author(s):  
Hong-De Wang ◽  
Tian-Rui Wang ◽  
Yao Sui ◽  
Juan Wang ◽  
Wei Chen ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Failure Load ◽  
Cruciate Ligament ◽  
Biomechanical Testing ◽  
Bone Tunnel ◽  
Histological Evaluation ◽  
New Bone Formation ◽  
Volume Of Interest ◽  
Anterior Cruciate

Background: The biomechanical and tendon-bone incorporation properties of allograft-augmented hybrid grafts for anterior cruciate ligament (ACL) reconstruction compared with traditional autografts are unknown. Hypothesis: Using an autograft for ACL reconstruction yields better results on biomechanical testing, radiographic analysis, and histological evaluation versus using a hybrid graft. Study Design: Controlled laboratory study. Methods: A total of 66 adult male Sprague Dawley rats underwent unilateral ACL reconstruction with an autograft (AT group; n = 33) or a hybrid graft (HB group; n = 33). The grafts used in both groups were harvested from the peroneus longus tendon and were fixed by suturing to the surrounding periosteum. Samples were harvested for biomechanical testing, micro–computed tomography (CT), and histological evaluation at 4, 8, and 12 weeks postoperatively. Bone tunnels on the femoral and tibial sides were divided into 3 subregions: intra-articular (IA), midtunnel (MT), and extra-articular (EA). A cylinder-like volume of interest in the bone tunnel and a tubular-like volume of interest around the bone tunnel were used to evaluate new bone formation and bone remodeling, respectively, via micro-CT. Results: In the AT group, there were significantly higher failure loads and stiffness at 8 weeks (failure load: 3.04 ± 0.40 vs 2.09 ± 0.54 N, respectively; P = .006) (stiffness: 3.43 ± 0.56 vs 1.75 ± 0.52 N/mm, respectively; P < .001) and 12 weeks (failure load: 9.10 ± 1.13 vs 7.14 ± 0.94 N, respectively; P = .008) (stiffness: 4.45 ± 0.75 vs 3.36 ± 0.29 N/mm, respectively; P = .008) than in the HB group. With regard to new bone formation in the bone tunnel, in the AT group, the bone volume/total volume (BV/TV) was significantly higher than in the HB group on the tibial side at 8 weeks (IA: 22.21 ± 4.98 vs 5.16 ± 3.98, respectively; P < .001) (EA: 19.66 ± 7.19 vs 10.85 ± 2.16, respectively; P = .030) and 12 weeks (IA: 30.50 ± 5.04 vs 17.11 ± 7.31, respectively; P = .010) (MT: 21.15 ± 2.58 vs 15.55 ± 4.48, respectively; P = .041) (EA: 20.75 ± 3.87 vs 10.64 ± 3.94, respectively; P = .003). With regard to bone remodeling around the tunnel, the BV/TV was also significantly higher on the tibial side at 8 weeks (MT: 33.17 ± 8.05 vs 15.21 ± 7.60, respectively; P = .007) (EA: 25.19 ± 6.38 vs 13.94 ± 7.10, respectively; P = .030) and 12 weeks (IA: 69.46 ± 4.45 vs 47.80 ± 6.16, respectively; P < .001) (MT: 33.15 ± 3.88 vs 13.76 ± 4.07, respectively; P < .001) in the AT group than in the HB group. Sharpey-like fibers had formed at 8 weeks in the AT group. A large number of fibroblasts withdrew at 12 weeks. In the AT group, the width of the interface was significantly narrower at 4 weeks (85.86 ± 17.49 vs 182.97 ± 14.35 μm, respectively; P < .001), 8 weeks (58.86 ± 10.99 vs 90.15 ± 11.53 μm, respectively; P = .002), and 12 weeks (42.70 ± 7.96 vs 67.29 ± 6.55 μm, respectively; P = .001) than in the HB group. Conclusion: Using an autograft for ACL reconstruction may result in improved biomechanical properties and tendon-bone incorporation compared with a hybrid graft. Clinical Relevance: Augmenting small autografts with allograft tissue may result in decreased biomechanical performance and worse tendon-bone incorporation, increasing the risk of graft failure.

Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review of Bone Graft Options for Tunnel Augmentation

2019 ◽  
Vol 48 (3) ◽  
pp. 767-777 ◽  
Author(s):  
Hytham S. Salem ◽  
Derek P. Axibal ◽  
Michelle L. Wolcott ◽  
Armando F. Vidal ◽  
Eric C. McCarty ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Bone Graft ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Bone Tunnel ◽  
Allograft Bone ◽  
Graft Material ◽  
Revision Acl Reconstruction ◽  
Anterior Cruciate

Background: No consensus is available regarding the optimal choice of bone graft material for bone tunnel augmentation in revision anterior cruciate ligament (ACL) surgery. Purpose: To compare the outcomes of different bone graft materials for staged revision ACL reconstruction. Study design: Systematic review. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. PubMed, EMBASE, and the Cochrane Library were queried through use of the terms anterior cruciate ligament and revision to identify all studies reporting outcomes of bone tunnel grafting in 2-stage revision ACL reconstruction. Data extracted included indications for 2-stage surgery, surgical technique, graft material, time between surgeries, rehabilitation protocols, physical examination findings, patient-reported outcomes, and radiographic and histologic findings. Results: The analysis included 7 studies with a total of 234 patients. The primary outcome in 2 studies was graft incorporation (mean follow-up, 8.8 months), whereas the other 5 studies reported clinical outcomes with follow-up mean ± SD of 4.2 ± 2.1 years. The indication for bone grafting and between-stage protocol varied among studies. Autograft was used in 4 studies: iliac crest bone autograft (ICBG, n = 3) and tibial bone autograft (TBA, n = 1). In 2 studies, the authors investigated the outcomes of allograft: allograft bone matrix (ABM) and allograft bone chips (AC). Finally, 1 study compared ICBG to a synthetic bone substitute. Radiographic evaluation of bone graft integration after the first stage was reported in 4 studies, with an average duration of 4.9 months. In 4 studies, the authors reported the time interval between first and second surgeries, with an average of 6.1 months for ICBG compared with 8.7 months for allogenic and synthetic grafts. Revision ACL graft failure rates were reported by 5 studies, including 1 study with ABM (6.1%), 1 study with AC (8.3%), 1 study with TBA (0%), and 2 studies with ICBG (0% and 2%). Conclusion: The indications for staged ACL reconstruction and the rehabilitation protocol between stages need to be clearly established. The available data indicate that autograft for bone tunnel grafting in 2-stage ACL revision may be associated with a lower risk of revision ACL reconstruction graft failure compared with allograft bone.

Effect of Tunnel-Graft Length on the Biomechanics of Anterior Cruciate Ligament-Reconstructed Knees

2008 ◽  
Vol 36 (11) ◽  
pp. 2158-2166 ◽  
Author(s):  
Thore Zantop ◽  
Mario Ferretti ◽  
Kevin M. Bell ◽  
Peter U. Brucker ◽  
Lars Gilbertson ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Structural Properties ◽  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Bone Tunnel ◽  
Anterior Cruciate ◽  
Graft Length

Background In anterior cruciate ligament (ACL) reconstruction using hamstring grafts, the graft can be looped, resulting in an increased graft diameter but reducing graft length within the tunnels. Hypothesis After 6 and 12 weeks, structural properties and knee kinematics after soft tissue ACL reconstruction with 15 mm within the femoral tunnel will be significantly inferior when compared with the properties of ACL reconstruction with 25 mm in the tunnel. Study Design Controlled laboratory study. Methods In an intra-articular goat model, 36 ACL reconstructions using an Achilles tendon split graft were performed with 15-mm (18 knees) and 25-mm (18 knees) graft length in the femoral tunnel. Animals were sacrificed 6 weeks and 12 weeks after surgery and knee kinematics was tested. In situ forces as well as the structural properties were determined and compared with those in an intact control group. Histologic analyses were performed in 2 animals in each group 6 and 12 weeks postoperatively. Statistical analysis was performed using a 2-factor analysis of variance test. Results Anterior cruciate ligament reconstructions with 15 mm resulted in significantly less anterior tibial translation after 6 weeks ( P < .05) but not after 12 weeks. Kinematics after 12 weeks and in situ forces of the replacement grafts at both time points showed no statistically significant differences. Stiffness, ultimate failure load, and ultimate stress revealed no statistically significant differences between the 15-mm group and the 25-mm group. Conclusion The results suggest that there is no negative correlation between short graft length (15 mm) in the femoral tunnel and the resulting knee kinematics and structural properties. Clinical Relevance Various clinical scenarios exist in which the length of available graft that could be pulled into the bone tunnel (femoral or tibial) could be in question. To address this concern, this study showed that reducing the tendon graft length in the femoral bone tunnel from 25 mm to 15 mm did not have adverse affects in a goat model.

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