Biomechanical analysis of three different types of fixators for anterior cruciate ligament reconstruction via finite element method: a patient-specific study

Abidin, Nur Afikah Zainal; Wahab, Abdul Hadi Abdul; Rahim, Rabiatul Adibah Abdul; Kadir, Mohammed Rafiq Abdul; Ramlee, Muhammad Hanif

doi:10.1007/s11517-021-02419-6

Cited by 13 publications

(6 citation statements)

References 87 publications

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“…In addition, Rodriguez et al [ 4 ] using synthetic grafts found no significant differences in terms of stiffness, failure strength, and elongation to failure before and after cyclic loading between both techniques. On the other hand, Abidin et al [ 20 ] in a biomechanical comparison of the two methods using finite element modeling and analysis reported that CP fixation was associated with better stability and lower stress and strain at fixators, bones, and menisci than the CB fixation. Hexter et al [ 21 ] in a sheep animal study underwent unilateral single-bundle ACLR using a porcine superflexor tendon xenograft.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Cross-Pin Versus Cortical Button Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft: A Long-Term Clinical Study and Review of the Literature

Chalidis,

Pitsilos,

Pavlopoulos

et al. 2024

Cureus

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Background Anterior cruciate ligament reconstruction (ACLR) is a common operative procedure and many options regarding the type of the selected graft and fixation technique have been described to date. Although many studies have addressed the issue of the optimal femoral fixation device during ACLR with a hamstring tendon (HT) autograft, no clear evidence to indicate one technique over another has been found. Objective The purpose of this study was to compare the long-term postoperative outcomes and complication rates between transfemoral Cross-pin (CP) and Endobutton-Cortical Button (CB) fixation techniques in patients undergoing ACLR with an HT autograft. Methods One hundred and seven consecutive patients underwent ACLR by using a quadruple HT autograft that was stabilized with either a CP (CP Group: 52 patients) or a CB (CB Group: 55 patients) fixation technique. The Lachman test (LT), the Pivot-shift test (PST), the side-to-side difference in anterior translation of the tibia, the International Knee Documentation Committee (IKDC), and the Lysholm knee scoring systems were evaluated before surgery and during long-term follow up. The femoral and tibial tunnel diameter was measured in the anteroposterior (AP) and lateral radiographs after surgery and at the final follow-up. A review of the literature was also carried out to identify any differences between both techniques. Results Study groups were comparable in terms of patient demographics. The mean follow-up was 10.4 ± 1.3 and 10.6 ± 1.3 years in the CP and CB Groups, respectively (p = 0.47). In the CP Group, improvements after surgery in LT and PST from grade 2 (n=34) or 3 (n=18) to grade 0 (n = 41) or 1 (n = 11) and from grade 2 (n=36) or 3 (n = 16) to grade 0 (n = 44) or 1 (n = 8), respectively, were observed. In the CB Group, similar improvements in LT and PST scores from grade 2 (n = 40) or 3 (n = 15) to grade 0 (n = 46) or 1 (n = 9) and from grade 2 (n = 41) or 3 (n = 14) to grade 0 (n = 47) or 1 (n = 8), respectively, were observed. However, no differences between the groups (p = 0.53 for LT and p = 0.90 for PST) were noted. The mean Lysholm scores were 89.7 ± 6.8 and 90.2 ± 7.2 in the CP and CB groups, respectively (p = 0.59). Side-to-side difference improved from 9.1 ± 2.8 to 1.7 ± 1.5 mm and from 8.6 ± 2.5 to 1.6 ± 1.4 mm in the CP and CB groups, respectively (p = 0.89 between groups). According to IKDC grades, 92.1% and 91.4% of knees in the CP and CB groups, respectively were reported to be Grade A (Normal) or B (Nearly Normal) with a p = 0.7. Femoral and tibial tunnel widening was found in the last follow-up in both groups. However, there was no difference in the degree of tunnel widening among the two techniques. With respect to LT, PST, anterior drawer test, and IKDC score, none of the 15 published comparative studies demonstrated any significant differences between the two techniques and only one study detected a difference regarding the Lysholm score in favor o...

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Section: Discussionmentioning

confidence: 99%

Comparison of Cross-Pin Versus Cortical Button Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft: A Long-Term Clinical Study and Review of the Literature

Chalidis,

Pitsilos,

Pavlopoulos

et al. 2024

Cureus

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“…According to the literature, bone, articular cartilage, and meniscus were modeled as isotropic, homogeneous, and continuous linear elastic materials, while ligaments and tendons were non-linear materials ( Fig. 2 C) [ 16 , 17 ]. Material property configuration was performed using MSC.…”

Section: Methodsmentioning

confidence: 99%

“…Patran (NASA Company, America) software. Then the material parameters of bone and soft tissue presented in Table 1 were set [ [17] , [18] , [19] ]. Frictionless contact conditions (with a friction coefficient set to 0.001) were set between the meniscus and the femoral articular cartilage, meniscus and tibial articular cartilage, femoral articular cartilage and tibial articular cartilage, and patellar articular cartilage and femoral articular cartilage, while the other structures were connected with shared nodes.…”

Section: Methodsmentioning

confidence: 99%

The application of human medical image-based finite element analysis in the construction of mouse osteoarthritis models

Dong,

Yang,

Zhang

et al. 2024

Heliyon

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“…Cyclic load testing showed similar amounts of graft displacement across all tested types of femoral fixation ( 56 ). Specifically examining femoral-sided fixation, one study found that cross-pin was found to have optimum stability with regard to stress and strain ( 38 ). This is in contrast to another study that found it to be biomechanically inferior to suspensory fixation ( 57 ).…”

Section: Comparison Of Fixation Methodsmentioning

confidence: 99%

“…In addition, the post only group was found to be biomechanically superior to the IFS cohort. Another comparison study on cross-pin fixation, IFS, and suspensory fixation found the cross-pin to have optimal stability regarding stress and strain at the femoral fixation site ( 38 ). In a systematic review on the effect of fixation methods on clinical outcomes, Speziali et al ( 39 ) reported a failure rate of 17.3% when a cross-pin was used on the femoral side, which is in contrast to 5.8% with suspensory fixation ( 39 ).…”

Section: Post Fixationmentioning

confidence: 99%

Biomechanical comparison of anterior cruciate ligament reconstruction fixation methods and implications on clinical outcomes

McDermott¹,

DeFoor²,

Blaber³

et al. 2023

Ann Joint

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Anterior cruciate ligament reconstruction (ACLR) is one of the more common surgeries encountered by orthopaedic surgeons, which has its inherent challenges due to the complex anatomy and biomechanical properties required to reproduce the function and stability of the native ACL. Multiple biomechanical factors from graft choice and tunnel placement to graft tensioning and fixation methods are vital in achieving a successful clinical outcome. Common methods of ACLR graft fixation in both the primary and revision setting are classified into compression/interference, suspensory, or hybrid fixation strategies with multiple adjunct methods of fixation. The individual biomechanical properties of these implants are crucial in facilitating early post-operative rehabilitation, while also withstanding the shear and tensile forces to avoid displacement and early graft failure during graft osseointegration. Implants within these categories include the use of interference screws (IFSs), as well as suspensory fixation with a button, posts, surgical staples, or suture anchors. Outcomes of comparative studies across the various fixation types demonstrate that compression fixation can decrease graft-tunnel motion, tunnel widening, and graft creep, at the risk of damage to the graft by IFSs and graft slippage. Suspensory fixation allows for a minimally invasive approach while allowing similar cortical apposition and biomechanical strength when compared to compression fixation. However, suspensory fixation is criticized for the risk of tunnel widening and increased graft-tunnel motion. Several adjunct fixation methods, including the use of posts, suture-anchors, and staples, offer biomechanical advantages over compression or suspensory fixation methods alone, through a second form of fixation in a second plane of motion. Regardless of the method or implant chosen for fixation, technically secure fixation is paramount to avoid displacement of the graft and allow for appropriate integration of the graft into the bone tunnel. While no single fixation technique has been established as the gold standard, a thorough understanding of the biomechanical advantages and disadvantages of each fixation method can be used to determine the optimal ACLR fixation method through an individualized patient approach.

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Biomechanical analysis of three different types of fixators for anterior cruciate ligament reconstruction via finite element method: a patient-specific study

Cited by 13 publications

References 87 publications

Comparison of Cross-Pin Versus Cortical Button Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft: A Long-Term Clinical Study and Review of the Literature

Comparison of Cross-Pin Versus Cortical Button Femoral Fixation in Anterior Cruciate Ligament Reconstruction With Hamstrings Autograft: A Long-Term Clinical Study and Review of the Literature

The application of human medical image-based finite element analysis in the construction of mouse osteoarthritis models

Biomechanical comparison of anterior cruciate ligament reconstruction fixation methods and implications on clinical outcomes

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