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

Adam, Frank; Pape, Dietrich; Schiel, Karin; Steimer, O.; Kohn, Dieter; Rupp, S.

doi:10.1177/0095399703258608

Cited by 60 publications

(40 citation statements)

References 39 publications

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“…While the use of young 7 Relationship between bioabsorbable interference screw divergence angle and construct displacement during cyclic testing (r 2 = 0.54) Fig. 8 Relationship between bioabsorbable interference screw divergence angle and load at failure (r 2 = 0.41) cadaveric femurs and tibiae would provide the most valid data for assessing soft tissue tendon graft fixation in a bone tunnel, the majority of cadaveric bones are from elderly specimens and have poor BMD which substantially lowers fixation strength [1,4,18]. In an active younger female population, proximal tibia apparent BMD [10,17,32] ranges from 1.07 to 1.3 g/ cm 2 while distal femur BMD ranges from 1.25 to 1.4 g/ cm 2 [10].…”

Section: Discussionmentioning

confidence: 99%

“…Porcine tissue use eliminates concerns over the poor quality of elderly cadaveric bone specimens, or the need to fill in osteoporotic cancellous cadaveric bone regions with polymer substances, thereby essentially creating a cadaveric-synthetic bone hybrid model [2]. No biomechanical study model is perfect or without limitations, and porcine bone does produce higher loads at failure, increased stiffness, and lower displacement during soft tissue tendon graft fixation compared to cadaveric bone specimens [1,20,23]. We propose however, that these effects may be reduced or otherwise adjusted for if the available porcine bones are screened for lower apparent BMD levels prior to study inclusion.…”

Section: Discussionmentioning

confidence: 99%

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Bioabsorbable screw divergence angle, not tunnel preparation method influences soft tissue tendon graft-bone tunnel fixation in healthy bone

Duffee

Brunelli

Nyland

et al. 2006

Knee Surg Sports Traumatol Arthr

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Bone tunnel fixation of a soft tissue tendon graft is the weak link immediately following ACL reconstruction. This biomechanical study evaluated the influence of extraction drilled or step dilated bone tunnels and bioabsorbable screw divergence on soft tissue tendon graft fixation. From an initial group of 50 available specimens, similar apparent bone mineral density porcine tibiae (1.2 +/- 0.24 g/cm2) were divided into two groups of ten specimens each. Group 1 (extraction drilled) received 9 mm diameter tunnels. Group 2 (step dilated) received 7 mm diameter tunnels that were dilated to 9 mm. Grafts were secured in tunnels using 10 mm diameter, 35 mm long tapered screws. After high resolution CT scanning to evaluate screw divergence, constructs were pretensioned on a servo hydraulic device between 10 and 50 N for 10 cycles, and isometric pretensioned at 50 N for 1 min, prior to 500 sub-maximal loading cycles (50-200 N) and load to failure testing at 20 mm/min. Wilcoxon Signed Rank tests and Mann-Whitney U-tests were used to evaluate group differences. Coefficient of determination values (r2) were calculated to further delineate statistically significant relationships. Tunnel preparation method did not display statistically significant effects on insertion torque, displacement during cyclic testing, relative stiffness during cyclic testing, load at failure, stiffness during load to failure testing or displacement during load to failure testing. Screw divergence < 15 degrees produced lower displacement and greater relative stiffness during cyclic testing and greater load at failure and stiffness during load to failure testing. Screw divergence angle displayed moderate relationships with construct displacement during cyclic testing (r2 = 0.54), stiffness during load to failure testing (r2 = 0.60), and load at failure (r2 = 0.41). Tunnel dilation does not enhance soft tissue tendon graft fixation strength in healthy bone. Bioabsorbable screw divergence of > or = 15 degrees significantly reduces soft tissue tendon graft-bone tunnel fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bioabsorbable screw divergence angle, not tunnel preparation method influences soft tissue tendon graft-bone tunnel fixation in healthy bone

Duffee

Brunelli

Nyland

et al. 2006

Knee Surg Sports Traumatol Arthr

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“…To this end, improvements in the fixation methods are at the forefront of clinical research to reduce the bone tunnel enlargement for tendon [337,338] and ligament [339,340]. Interferential screws, bioabsorbable or metalling in origin [341], are considered as the gold standard for tendon-to-bone fixation and for ligament reconstruction [342][343][344]. However, recent data demonstrate viscoelastic deformation, which causes widening of the bone tunnel into which the tendon is inserted, resulting in slippage of the tendon [345].…”

Section: Sutures and Screwsmentioning

confidence: 99%

The past, present and future in scaffold-based tendon treatments

Lomas

Ryan

Sorushanova

et al. 2015

Advanced Drug Delivery Reviews

183

188

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“…The patella tendon grafts were loaded through bony attachments to mimic the in vivo condition, although fixation of the bone plugs within the femur and tibia was not simulated. A previous study 29 indicated that fixation of a bone plug with an interference screw produces a fixation stiffness greater than 1000 N/mm for loads up to 100 N. Therefore, for this study, bone plugs were assumed to be rigidly fixed.…”

Section: Comparison Of Graft Tension and Stiffnessmentioning

confidence: 99%

In vitro comparison of tension and stiffness between hamstring tendon and patella tendon grafts

Elias¹,

Surya²,

Ciccone³

2008

Journal Orthopaedic Research

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Following anterior cruciate ligament reconstruction, grafts relax and warm from the temperature of the operating room to body temperature. The current study compared graft tension and stiffness between patella tendon and hamstring tendon grafts. Six quadruple strand hamstring tendon grafts and six patella tendon grafts were preconditioned and loaded to 105 N while at 208C. Graft tension and stiffness were measured after 15 min, after an additional 4 h, and after increasing the temperature to 348C. A two-way repeated-measures analysis of variance and a post hoc test were used to compare the measurements between the two types of graft and identify significant ( p < 0.05) changes for each type of graft. Tension was significantly larger for the patella tendon grafts, although the stiffness values were not significantly different ( p > 0.8). For both types of graft, tension and stiffness decreased significantly with time and the temperature increase. The lowest tension and stiffness measurements were 50 AE 11 N and 129 AE 35 N/mm, respectively, for the patella tendon grafts, compared to 18 AE 5 N and 115 AE 11 N/mm, respectively, for the hamstring tendon grafts. Both types of graft lose tension to relaxation and a temperature increase, but the tension loss is larger for hamstring tendon grafts. Initial tension is applied to autografts used for anterior cruciate ligament reconstruction to limit postoperative knee laxity. Recommended initial tension levels range from 20 to 90 N for patella tendon grafts [1][2][3][4][5] and from 70 to 80 N 1,6,7 for hamstring tendon grafts. Following reconstruction, viscoelastic relaxation decreases the tension within a graft. Hamstring tendon grafts are typically preconditioned on a graft board at approximately 89 N 8-11 to minimize the tension loss. Two in vitro studies that mimicked preconditioning and application of initial tension determined that the tension within hamstring tendon grafts decreases by more than 50% within an hour.10,12 Patella tendon grafts are not typically preconditioned outside the knee prior to reconstruction, presumably due to the belief that patella tendon grafts are less susceptible to relaxation. A 50% decrease in tension over 15 min has been measured for patella tendon grafts that were not preconditioned immediately prior to application of tension.13 As the graft tension decreases, the stiffness needed to maintain knee stability increases.14 The stiffness of hamstring tendon grafts has been shown to decrease as the tension decreases. 12 The relationship between stiffness and tension has not been determined for patella tendon grafts.Graft tension and stiffness can also decrease due to an increase in temperature. Autografts typically cool to the temperature of the operating room prior to implantation in the knee and warm to body temperature postoperatively. Following complete relaxation, an increase in temperature from operating room to body temperature has been shown to decrease the tension and stiffness of hamstring tendon grafts by approximately...

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

Abstract: 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.

Cited by 60 publications

References 39 publications

Bioabsorbable screw divergence angle, not tunnel preparation method influences soft tissue tendon graft-bone tunnel fixation in healthy bone

Bioabsorbable screw divergence angle, not tunnel preparation method influences soft tissue tendon graft-bone tunnel fixation in healthy bone

The past, present and future in scaffold-based tendon treatments

In vitro comparison of tension and stiffness between hamstring tendon and patella tendon grafts

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