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This Article Full Text Full Text (PDF) All Versions of this Article: 32/7/1723    most recent 0363546503262692v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Jagodzinski, M. Articles by Bosch, U. Search for Related Content PubMed PubMed Citation Articles by Jagodzinski, M. Articles by Bosch, U. Related Collections Reconstruction Patella Graft fixation

Femoral Press-Fit Fixation of the Hamstring Tendons for Anterior Cruciate Ligament Reconstruction

Michael Jagodzinski, MD^*,, Vahid Behfar, Christof Hurschler, PhD, Knut Albrecht, PhD, Christian Krettek, PhD and Ulrich Bosch, PhD^||

From the Department of Trauma Surgery, Hanover Medical School, the Laboratory for Biomechanics and Experimental Orthopedics, Department of Orthopedics, Hanover Medical School, the Department of Forensic Medicine, Hanover Medical School, and the ^|| Center of Orthopedics and Sports Traumatology of the INI, Hanover, Germany

^* Address correspondence to Michael Jagodzinski, MD, Department of Trauma Surgery, Hanover Medical School, Carl-Neuberg-Str. 1, 30625 Hanover, Germany (e-mail: Michael{at}Jagodzinski.com).

Background: Press-fit fixation of patellar tendon–bone anterior cruciate ligament autografts is an interesting technique because no hardware is necessary. For hamstring tendon grafts, no biomechanical data exist of a press-fit procedure.

Hypothesis: Press-fit femoral fixation of hamstring tendons is mechanically equivalent to press-fit patellar tendon–bone fixation.

Study Design: Controlled laboratory study.

Methods: Patellar and hamstring tendons of 30 human cadavers (age, 53.8 ± 18.0 years) were used. An outside-in press-fit fixation with a knot in the semitendinosus and gracilis tendons and an inside-out and outside-in fixation with the tendons wrapped around a bone block were compared with patellar tendon–bone press-fit fixation in 30 ovine femora. Constructs were cyclically strained and then loaded until failure. Maximum load to failure, stiffness, and elongation during failure testing and cyclical loading were investigated.

Results: The maximum load to failure was 561 ± 309 N for the patellar tendon, 599 ± 234 N for the semitendinosus/gracilis tendons knot construct, 678 ± 231 for the semitendinosus/gracilis tendons bone construct inserted outside in, and 339 ± 236 for the semitendinosus/gracilis tendons bone construct inserted inside out (inferior to the others; analysis of variance, Dunn test, P < .01). Stiffness of the constructs averaged 134 ± 32 N/mm for the patellar tendon, 124 ± 21 N/mm for the knot construct, 118 ± 27 N/mm for the outside-in fixation, and 117 ± 23 N/mm for inside-out fixation. Elongation during initial cyclical loading was 0.7 ± 0.6 mm for the patellar tendon, 1.6 ± 0.5 mm for the knot construct, 1.9 ± 1.2 mm for the outside-in fixation, and 1.9 ± 0.9 mm for the inside-out fixation (significantly larger for all semitendinosus/gracilis tendon techniques, P < .05).

Conclusions: Failure loads for the semitendinosus/gracilis tendons bone construct inserted outside in and the semitendinosus/ gracilis tendons knot construct were within the confidence interval of the patellar tendon press-fit fixation. All semitendinosus/ gracilis tendon graft techniques exhibited larger elongation during initial cyclical loading than the patellar tendon graft. There was no difference in stiffness between all techniques.

Clinical Relevance: Two of the 3 hamstring press-fit fixation techniques showed loads to failure similar to the patellar tendon fixation. Preconditioning of the constructs is critical. These results must be interpreted with care because of high standard deviations.

Key Words: press-fit fixation • anterior cruxiate ligament (ACL) • patella • hamstring

This article has been cited by other articles:

				R. H. P. Kilger, M. Thomas, S. Hanford, D. A. Alaseirlis, H. H. Paessler, and S. L-Y. Woo The Effectiveness of Reconstruction of the Anterior Cruciate Ligament Using the Novel Knot/Press-Fit Technique: A Cadaveric Study Am. J. Sports Med., June 1, 2005; 33(6): 856 - 863. [Abstract] [Full Text] [PDF]