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The American Journal of Sports Medicine 30:167-173 (2002)
© 2002 American Orthopaedic Society for Sports Medicine

Compaction Versus Extraction Drilling for Fixation of the Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction

Janne T. Nurmi, DVM*,{dagger}, Teppo L. N. Järvinen, MD, PhD*,{dagger},{ddagger}, Pekka Kannus, MD, PhD*,§,||, Harri Sievänen, DSc||, Jani Toukosalo, MBAa and Markku Järvinen, MD, PhD*,{dagger}

* Medical School and Institute of Medical Technology, University of Tampere, Finland
{dagger} Department of Surgery, Tampere University Hospital, Finland
§ Tampere Research Center of Sports Medicine, Finland
|| The Bone Research Group, Urho Kaleva Kekkonen Institute, Tampere, Finland
a Smith & Nephew Finland, Vantaa, Finland, Finland

{ddagger} Address correspondence and reprint requests to Teppo L. N. Järvinen, MD, PhD, University of Tampere/Institute of Medical Technology, 33 014 Tampereen Yliopisto, Finland

Initial strength of quadrupled hamstring tendon grafts fixed with titanium interference screws was assessed in 30 pairs of porcine tibiae. Bone tunnels were drilled with either compaction drilling (stepped routers) or conventional extraction drilling (cannulated drill bits). Fifteen pairs of specimens were subjected to a single-cycle load-to-failure test, while the rest underwent a cyclic-loading test to further assess the quality of the fixation. No significant difference between the two drilling techniques was found with regard to yield load, displacement at yield load, stiffness, or mode of failure. Porcine trabecular bone mineral density was determined using peripheral quantitative computed tomography and compared with that of young women and men at a site corresponding to that of the tibial bone drill hole of an anterior cruciate ligament reconstruction. There was a significant difference between the two species (210 ± 45 mg/cm3 in porcine tibial bone versus 129 ± 30 mg/cm3 in women and 134 ± 34 mg/cm3 in men), suggesting that porcine knee specimens may have limitations in studies of graft fixation in anterior cruciate ligament reconstruction. We found no difference between extraction and compaction drilling in initial fixation strength of a hamstring tendon graft for anterior cruciate ligament reconstruction using a porcine model.




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