A biomechanical comparison of anterior cruciate ligament suspensory fixation devices in a porcine cadaver model

Rylander, Lucas S.; Brunelli, Jeffrey A.; Taylor, Michal L; Baldini, Todd; Ellis, Byron; Hawkins, Monica; McCarty, Eric C.

doi:10.1016/j.clinbiomech.2013.11.001

Cited by 19 publications

(10 citation statements)

References 18 publications

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“…2,18,20,27,30 Whereas confident estimations on repetitive ACL forces during rehabilitation activities are lacking, 27 a review of the relevant literature revealed the force interval between 50 and 250 N is the most common used for cyclic testing. 2,18,21,24,[29][30][31]37 To date, it is unclear what amount of fixation lengthening constitutes clinical failure. 30 Tibial anterior translation >3.0 mm is indicative for ACL rupture with high sensitivity 16,17 and is, therefore, often used as a threshold to determine clinical failure in isolated device testing.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction

Götschi

Rosenberg

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Implant fixation by means of a cortical fixation device (CFD) has become a routine procedure in anterior cruciate ligament reconstruction. There is no clear consensus whether adjustable-length CFDs are more susceptible to loop lengthening when compared with pretied fixed-length CFDs.Purpose: To assess biomechanical performance measures of 3 types of CFDs when subjected to various loading protocols.Study Design: Controlled laboratory study.Methods: Three types of CFDs underwent biomechanical testing: 1 fixed length and 2 adjustable length. One of the adjustablelength devices is based on the so-called finger trap mechanism, and the other is based on a modified sling lock mechanism. A device-only test of 5000 cycles (n ¼ 8 per group) and a tendon-device test of 1000 cycles (n ¼ 8 per group) with lower and upper force limits of 50 and 250 N, respectively, were applied, followed by ramp-to-failure testing. Adjustable-length devices then underwent further cyclic testing with complete loop unloading (n ¼ 5 per group) at each cycle, as well as fatigue testing (n ¼ 3 per group) over a total of 1 million cycles. Derived mechanical parameters were compared among the devices for statistical significance using Kruskal-Wallis analysis of variance followed by post hoc Mann-Whitney U testing with Bonferroni correction.Results: All CFDs showed elongation <2 mm after 5000 cycles when tested in an isolated manner and withstood ultimate tensile forces in excess of estimated peak in vivo forces. In both device-only and tendon-device tests, differences in cyclic performance were found among the devices, favoring adjustable-length fixation devices over the fixed-length device. Completely unloading the suspension loops, however, led to excessive loop lengthening of the finger trap device, whereas the modified sling lock device remained stable throughout the test. The fixed-length device displayed superior ultimate strength over both adjustable-length devices. Both adjustable-length devices showed adequate fatigue behavior during high-cyclic testing.Conclusion: All tested devices successfully prevented critical construct elongation when tested with constant tension and withstood ultimate loads in excess of estimated in vivo forces during the rehabilitation phase. The finger trap device gradually lengthened excessively when completely unloaded during cyclic testing.Clinical Relevance: Critical loop lengthening may occur if adjustable-length devices based on the finger trap mechanism are repeatedly unloaded in situ.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction

Götschi

Rosenberg

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Some mechanical studies that compared adjustable-loop devices and fixed-loop devices reported that the latter showed higher breaking strength and less displacement Takahashi and Takahashi Journal of Experimental Orthopaedics (2020) 7:17 [18][19][20][21][22][23][24][25]. On the other hand, other studies reported no difference in either parameter [26,27]. One clinical study reported no differences between the two types of devices in evaluations using the KT-1000 [28].…”

Section: Discussionmentioning

confidence: 99%

The improved cortical button shows better breaking strength of sutures compared with 10 original cortical button after cyclic loading

Takahashi

2020

J EXP ORTOP

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Background: Suspensory cortical buttons are widely used for fixation of reconstructed ligaments during anterior cruciate ligament (ACL) reconstruction because they have high usability and a favorable fixing force. However, it is not always easy to fix a reconstructed ACL while maintaining appropriate ligament tension. Therefore, we developed an improved cortical button that provides temporary tension until suturing is completed. Methods: Button holes of our improved EndoButton are not perpendicular to the bone surface on which the button is placed, but have an angle of 45 degrees so that the button can be temporarily fixed by applying tension to the suture. The improved EndoButton and the original EndoButton (Smith & Nephew Inc., Andover, Massachusetts) were each tied to FiberWire 5/7 metric (5 M) (manufactured by Arthrex). Ten cycles of preliminary loading (0-50 N) were applied to each suture, followed by test loading (0-250 N) for 500 or 1000 cycles. Then, a tensile test was performed at a displacement velocity of 20 mm/min. Results: The breaking strength of the sutures of the improved EndoButton were tend to higher than those of the sutures of the original EndoButton after 1000 loading cycles (p = 0.067, d = 0.883). The moduli of rigidity of the sutures of the improved EndoButton were higher than those of the sutures of the original EndoButton after 500 loading cycles (p = 0.027) and remained almost the same regardless of the number of loading cycles. Conclusion: We found that compared with the original cortical button, the improved cortical button was better able to retain suture breaking strength and modulus of rigidity, regardless of the number of load cycles.

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“…Graft traction was made in the same line as the tibial tunnel, simulating the worst possible scenario. 5 , 25 , 26 , 27 Future studies, which consider the above limitations, are necessary to determine the mechanical efficacy of the extra-tunnel staple associated with an interference screw in the tibial fixation of quadrupled flexor tendon grafts.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of a double fixation method for tendon graft in porcine tibia – using an interference screw plus staple

Bauer

Alberti

Corotti

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveThe aim of the study was to compare the mechanical behavior of interference screw tibial fixation vs. screw-plus-staple tibial fixation in an animal model.MethodsThirty-six pieces of swine knee specimens were selected and divided into two groups: Group 1, tibial fixation with interference screw (n = 17), and Group 2, fixation with interference screw and staple (n = 19). The models were submitted to a single cycle of tension testing. The following variables were measured: graft cross-sectional area, failure point on 10 mm (F10), yield load (Fy), and stiffness.ResultsThe mean values of graft cross-sectional area, F10, Fy, and stiffness did not present significant differences between the groups.ConclusionThe addition of a second staple-type ligament fixation device, complementing the interference screw, did not increase the mechanical safety of the system.

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A biomechanical comparison of anterior cruciate ligament suspensory fixation devices in a porcine cadaver model

Cited by 19 publications

References 18 publications

Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction

Biomechanical Evaluation of a Novel Loop Retention Mechanism for Cortical Graft Fixation in ACL Reconstruction

The improved cortical button shows better breaking strength of sutures compared with 10 original cortical button after cyclic loading

Biomechanical analysis of a double fixation method for tendon graft in porcine tibia – using an interference screw plus staple

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