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Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
Different surgical methods of graft fixation in ACL re construction were examined to determine the effects on mechanical properties of the reconstructed ACL. Ten human cadavers were used in this study. Six different types of grafts were studied. The tendon grafts were removed from each cadaver and fixed to femurs and tibias as ACL substitutes with different surgical fixation methods, leaving femur-reconstructed graft- tibia preparations. The surgical techniques used were staple fixation, tying sutures over buttons, and screw fixation. In the latter, the screws were introduced through femoral and tibial drill holes from the outside in order to achieve interference fit as described by Lam bert. Tensile testing demonstrated that the original ACL is significantly stronger than the graft used for recon struction in linear load, stiffness, and maximum tensile strength. All of the failures of the reconstructed ACL grafts occurred at the fixation site, indicating that the mechanically weak link of the reconstructed graft is located at the fixation site. Among the different meth ods of fixation, one-third of the patellar tendon secured with a cancellous screw, especially with a custom de signed large diameter screw, showed significantly higher values. Although many other factors affect the success of ACL reconstruction, our study indicates that the method of surgical fixation is the major factor influencing the graft's mechanical properties in the im mediate postoperative period.
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J. Kartus, L. Ejerhed, N. Sernert, S. Brandsson, and J. Karlsson Comparison of Traditional and Subcutaneous Patellar Tendon Harvest: A Prospective Study of Donor Site-Related Problems After Anterior Cruciate Ligament Reconstruction Using Different Graft Harvesting Techniques Am. J. Sports Med., May 1, 2000; 28(3): 328 - 335. [Abstract] [Full Text] [PDF]
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A. Weiler, R. F.G. Hoffmann, C. J. Siepe, S. F. Kolbeck, and N. P. Sudkamp The Influence of Screw Geometry on Hamstring Tendon Interference Fit Fixation Am. J. Sports Med., May 1, 2000; 28(3): 356 - 359. [Abstract] [Full Text] [PDF]
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M. Yamanaka, K. Yasuda, H. Tohyama, H. Nakano, and T. Wada The Effect of Cyclic Displacement On the Biomechanical Characteristics of Anterior Cruciate Ligament Reconstructions Am. J. Sports Med., November 1, 1999; 27(6): 772 - 777. [Abstract] [Full Text] [PDF]
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D. M. Stadelmaier, W. R. Lowe, O. A. Ilahi, P. C. Noble, and H. W. Kohl III Cyclic Pull-Out Strength of Hamstring Tendon Graft Fixation with Soft Tissue Interference Screws: Influence of Screw Length Am. J. Sports Med., November 1, 1999; 27(6): 778 - 783. [Abstract] [Full Text] [PDF]
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I. S. Corry, J. M. Webb, A. J. Clingeleffer, and L. A. Pinczewski Arthroscopic Reconstruction of the Anterior Cruciate Ligament: A Comparison of Patellar Tendon Autograft and Four-Strand Hamstring Tendon Autograft Am. J. Sports Med., July 1, 1999; 27(4): 444 - 454. [Abstract] [Full Text] [PDF]
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R. Seil, S. Rupp, P. W. Krauss, A. Benz, and D. M. Kohn Comparison of Initial Fixation Strength Between Biodegradable and Metallic Interference Screws and a Press-Fit Fixation Technique in a Porcine Model Am. J. Sports Med., November 1, 1998; 26(6): 815 - 819. [Abstract] [Full Text] [PDF]
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B. D. Beynnon, C. M. Meriam, S. H. Ryder, B. C. Fleming, and R. J. Johnson The Effect of Screw Insertion Torque on Tendons Fixed with Spiked Washers Am. J. Sports Med., July 1, 1998; 26(4): 536 - 539. [Abstract] [Full Text] [PDF]
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T. R. Stapleton, J. I. Waldrop, C. R. Ruder, T. A. Parrish, and T. E. Kuivila Graft Fixation Strength with Arthroscopic Anterior Cruciate Ligament Reconstruction: Two-Incision Rear Entry Technique Compared With One-Incision Technique Am. J. Sports Med., May 1, 1998; 26(3): 442 - 445. [Abstract] [Full Text] [PDF]
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D. Otto, L. A. Pinczewski, A. Clingeleffer, and R. Odell Five-Year Results of Single-Incision Arthroscopic Anterior Cruciate Ligament Reconstruction with Patellar Tendon Autograft Am. J. Sports Med., March 1, 1998; 26(2): 181 - 188. [Abstract] [Full Text] [PDF]
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 K. D. PLANCHER, J. R. STEADMAN, K. K. BRIGGS, and K. S. HUTTON Reconstruction of the Anterior Cruciate Ligament in Patients Who Are at Least Forty Years Old. A Long-Term Follow-up and Outcome Study J. Bone Joint Surg. Am., February 1, 1998; 80(2): 184 - 97. [Abstract] [Full Text]
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A. Weiler, H. J. Windhagen, M. J. Raschke, A. Laumeyer, and R. F. G. Hoffmann Biodegradable Interference Screw Fixation Exhibits Pull-Out Force and Stiffness Similar to Titanium Screws Am. J. Sports Med., January 1, 1998; 26(1): 119 - 128. [Abstract] [Full Text] [PDF]
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G. T. Davies and W.-K. Pun Fixation of the Tibial Bone Block in Patellar Tendon Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., September 1, 1997; 25(5): 691 - 691. [PDF]
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N. J. Rowden, D. Sher, G. J. Rogers, and K. Schindhelm Anterior Cruciate Ligament Graft Fixation: Initial Comparison of Patellar Tendon and Semitendinosus Autografts in Young Fresh Cadavers Am. J. Sports Med., July 1, 1997; 25(4): 472 - 478. [Abstract] [PDF]
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K. R. Blickenstaff, W. A. Grana, and D. Egle Analysis of a Semitendinosus Autograft in a Rabbit Model Am. J. Sports Med., July 1, 1997; 25(4): 554 - 559. [Abstract] [PDF]
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K. Yasuda, J. Tsujino, Y. Tanabe, and K. Kaneda Effects of Initial Graft Tension on Clinical Outcome After Anterior Cruciate Ligament Reconstruction: Autogenous Doubled Hamstring Tendons Connected in Series with Polyester Tapes Am. J. Sports Med., January 1, 1997; 25(1): 99 - 106. [Abstract] [PDF]
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H. Tohyama, B. D. Beynnon, R. J. Johnson, P. A. Renstrom, and S. W. Arms The Effect of Anterior Cruciate Ligament Graft Elongation at the Time of Implantation on the Biomechanical Behavior of the Graft and Knee Am. J. Sports Med., September 1, 1996; 24(5): 608 - 614. [Abstract] [PDF]
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D. E. Cooper and T. W. Wilson Clinical Failure of Tibial Interference Screw Fixation After Anterior Cruciate Ligament Reconstruction: A Report of Two Cases Am. J. Sports Med., September 1, 1996; 24(5): 693 - 697. [PDF]
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D. B. O'NEILL Arthroscopically Assisted Reconstruction of the Anterior Cruciate Ligament. A Prospective Randomized Analysis of Three Techniques J. Bone Joint Surg. Am., June 1, 1996; 78(6): 803 - 13. [Abstract] [Full Text]
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F. Pena, T. Grontvedt, G. A. Brown, A. K. Aune, and L. Engebretsen Comparison of Failure Strength Between Metallic and Absorbable Interference Screws: Influence of Insertion Torque, Tunnel-Bone Block Gap, Bone Mineral Density, and Interference Am. J. Sports Med., June 1, 1996; 24(3): 329 - 334. [Abstract] [PDF]
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K. Pierz, M. Baltz, and J. Fulkerson The Effect of Kurosaka Screw Divergence on the Holding Strength of Bone-Tendon-Bone Grafts Am. J. Sports Med., June 1, 1995; 23(3): 332 - 335. [Abstract] [PDF]
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