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Biomechanical Properties of Patellar and Hamstring Graft Tibial Fixation Techniques in Anterior Cruciate Ligament Reconstruction

Experimental Study With Roentgen Stereometric Analysis

From the Department of Orthopaedic Surgery, Laboratory for Radiostereometric Analysis (RSA), Saarland University Medical Center, Homburg/Saar, Germany

^* Address correspondence and reprint requests to Dr. Frank Adam, Universitätskliniken des Saarlandes, Orthopädische Klinik und Poliklinik, D-66421 Homburg/Saar, Germany.

Background: Reliable fixation of the soft hamstring grafts in ACL reconstruction has been reported as problematic.

Hypothesis: The biomechanical properties of patellar tendon (PT) grafts fixed with biodegradable screws (PTBS) are superior compared to quadrupled hamstring grafts fixed with BioScrew (HBS) or Suture-Disc fixation (HSD).

Study Design: Controlled laboratory study with roentgen stereometric analysis (RSA).

Methods: Ten porcine specimens were prepared for each group. In the PT group, the bone plugs were fixed with a 7 x 25 mm BioScrew. In the hamstring group, four-stranded tendon grafts were anchored within a tibial tunnel of 8 mm diameter either with a 7 x 25 mm BioScrew or eight polyester sutures knotted over a Suture-Disc. The grafts were loaded stepwise, and micromotion of the graft inside the tibial tunnel was measured with RSA.

Results: Hamstring grafts failed at lower loads (HBS: 536 N, HSD 445 N) than the PTBS grafts (658 N). Stiffness in the PTBS group was much greater compared to the hamstring groups (3500 N/mm versus HBS = 517 N/mm and HSD = 111 N/mm). Irreversible graft motion after graft loading with 200 N was measured at 0.03 mm (PTBS), 0.38mm (HBS), and 1.85mm (HSD). Elasticity for the HSD fixation was measured at 0.67 mm at 100 N and 1.32 mm at 200 N load.

Conclusion: Hamstring graft fixation with BioScrew and Suture-Disc displayed less stiffness and early graft motion compared to PTBS fixation. Screw fixation of tendon grafts is superior to Suture-Disc fixation with linkage material since it offers greater stiffness and less graft motion inside the tibial tunnel.

Clinical Relevance: Our results revealed graft motion for hamstring fixation with screw or linkage material at loads that occur during rehabilitation. This, in turn, may lead to graft laxity.

Key Words: anterior cruciate ligament • ACL • reconstruction • hamstrings • BPTB-graft • biomechanics • roentgen stereometric analysis • RSA

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