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Graft Fixation Strength with Arthroscopic Anterior Cruciate Ligament Reconstruction

Two-Incision Rear Entry Technique Compared With One-Incision Technique

Timothy R. Stapleton, MD^*, John I. Waldrop, MD^*,, Craig R. Ruder, MD, Todd A. Parrish, MD and Thomas E. Kuivila, MD

^* The Hughston Orthopaedic Clinic, P.C., Columbus, Georgia, Wilford Hall, USAF Medical Center, San Antonio, Texas

Address correspondence and reprint requests to John I. Waldrop, MD, The Hughston Clinic, P.C., 6262 Veterans Parkway, Columbus, GA 31908

To compare the fixation strengths of two arthroscopic anterior cruciate ligament reconstruction techniques, we harvested 10-mm bone-patellar tendon-bone grafts with 25-mm bone plugs from 12 fresh-frozen cadaveric knees. One knee of each pair was fixed using Acufex instruments and the two-incision technique; one knee was fixed using Arthrotek instruments and the one-incision technique. We used cannulated 9 x 25 mm Kurosaka screws for femoral and tibial tunnel fixation. All knees were mounted on the Instron Test System and were stressed to failure by recreating a pivot shift maneuver. The one-incision technique graft fixation was significantly stronger (mean failure, 695 N) than that with the two-incision technique (mean failure, 593 N). In all one-incision technique knees, either the patellar tendon graft avulsed off a bone plug or the plug broke. In five of six two-incision technique knees, the tibial bone plug pulled out around the interference screw. Patellar tendon graft length ranges from 90 to 105 mm, and the average two-incision technique tunnel length is 120 mm. The interference screw compressed the femoral bone plug into cortical bone but compressed the tibial bone plug into cancellous bone in the two-incision technique, while in the one-incision technique the bone plug was compressed into cortical bone on both sides.

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