Can the body slope of interference screw affect initial stability of reconstructed anterior cruciate ligament?: An in-vitro investigation

Daneshvarhashjin, Nazanin; Chizari, Mahmoud; Mortazavi, SM Javad; Rouhi, Gholamreza

doi:10.1186/s12891-021-04446-8

Cited by 10 publications

(10 citation statements)

References 34 publications

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“…Wang JH et al noted that interference screws containing β-tricalcium phosphate, which reduced TE near the screws compared with pure poly-L-lactic acid (PLLA) screw [ 39 ]. Agarwal S et al found that a higher slope tapered interference screw could cause less damage to graft fibers, reducing graft laxity and increasing fixation stability compared to a low slope tapered interference screw [ 40 ]. However, it remains unclear whether the relative position between interference screw and graft can affect TE.…”

Section: Discussionmentioning

confidence: 99%

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

et al. 2023

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Background and Objectives: Tunnel enlargement (TE) is a widely reported phenomenon after anterior cruciate ligament reconstruction (ACLR). Given the paucity of knowledge in the literature, it remains unclear whether screw position in the tunnel affects TE. This retrospective cohort study evaluated differences in postoperative tunnel enlargement rates (TER) and clinical results between anterior and posterior tibial interference screw insertion during single-bundle ACLR using autologous hamstring grafts. Materials and Methods: A group of consecutive patients that underwent primary arthroscopic single-bundle ACLR in our hospital were screened and divided into two groups based on the position of the tibial interference screw (determined by Computer Tomography within 3 days after surgery): anterior screw position group (A) and posterior screw position group (B). The bone tunnel size was measured using magnetic resonance imaging (MRI) performed 1 year after surgery. International Knee Documentation Committee (IKDC) score and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were used for clinical results 1 year postoperatively. Results: 87 patients were included. The TER of Group A is higher than that of Group B (43.17% vs. 33.80%, p = 0.024). Group A showed a significant increase (12.1%) in enlargement rates at the joint line level than group B (43.77% vs. 31.67%, p = 0.004). Moreover, KOOS and IKDC scores improved in both groups. There were no significant differences in clinical outcomes between the two groups. Conclusions: One year after ACLR, patients with posterior screw showed significantly lower TE than patients with anterior screw. However, the position of screw did not lead to differences in clinical results over our follow-up period. Posterior screw position in the tibial tunnel maybe a better choice in terms of reducing TE. Whether the different screw positions affect the long-term TE and long-term clinical outcomes needs to be confirmed by further studies.

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Section: Discussionmentioning

confidence: 99%

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

et al. 2023

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“…Daneshvarhashjin et al [ 12 ] investigated the effect of the body slope profile of the interference screw on the initial stability of the ACL reconstruction and suggested (1) avoiding high contact pressure from the tip to one-third of its length, and (2) a proper graft fitting is essential in the last two-thirds of the screw length since major graft slippage occurs in this region. Moreover, a tunnel diameter equal to or 1 mm larger than the screw diameter provides a better fixation compared to a 1 mm smaller tunnel diameter [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…The results found differences in fixation performance, but they were not statistically significant [ 10 ]. However, Athwal et al showed that screw tip design has an influence on the fixation performance [ 11 ], and the study of the IS body slope showed that it also influenced the fixation strength [ 12 ]. The use of a permanent metal IS has some disadvantages, including graft damage, tunnel widening, imaging modalities, required implant removal surgery, and increased difficulty in revision surgeries [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

In Vitro Investigation of the Fixation Performance of a Bioabsorbable Magnesium ACL Interference Screw Compared to a Conventional Interference Screw

Siroros

Merfort

Liu

et al. 2023

Life

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An anterior cruciate ligament (ACL) reconstruction is a common treatment for patients with ACL rupture that aims to regain pre-injury knee stability and kinematics. During the ACL reconstruction, one method to fix the graft is the use of an interference screw (IS). The IS should provide initial stability and secure the graft during the healing period. In recent years, magnesium has emerged as an alternative material to permanent metal and polymer ISs. In addition, differences in designs, such as the shape of the IS, can influence the fixation performance of the IS. Therefore, in this biomechanical experiment, two different screw designs with two ligament materials were compared in an insertion and a pull-out test at a rate of 1 mm/s. The screw designs were a conventional polymer screw and a magnesium screw. Porcine tendon and nylon rope were used as ligament materials. All tests were performed in polyurethane foam blocks with 15 PCF density (Synbone AG, Switzerland). As a result, both screw designs required an insertion torque of less than 3 Nm. There was a significant difference between the porcine and nylon rope in pull-out tests for each screw design. The magnesium screw had the highest pull-out force at 412.14 ± 50.00 N for porcine tendon and 707.38 ± 21.81 N for nylon rope. There were no significant differences in tunnel widening (narrow–wide ratio) between each ligament material. The magnesium screw showed the lowest narrow–wide tunnel ratio, implying a better ability to compress the graft to the tunnel. In conclusion, a more optimized magnesium IS design resulted in better graft fixation and an improved ACL reconstruction outcome.

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“…Among various techniques in ACL reconstruction, using interference screw is the gold standard technique [ 7 , 8 ]{Sarzaeem, 2014 #392}. In this technique, different types of grafts could be used as a substitute for a torn ACL.…”

Section: Introductionmentioning

confidence: 99%

Comparison of mechanical properties in interference screw fixation technique and organic anterior cruciate ligament reconstruction method: a biomechanical study

Borjali

Nourani

Moeinnia

et al. 2021

BMC Musculoskelet Disord

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Background Bone and Site Hold Tendon Inside (BASHTI) technique is an organic implant-less technique for anterior cruciate ligament (ACL) reconstruction with some clinical advantages, such as speeding up the healing process, over implantable techniques. The study aims to compare the mechanical properties of BASHTI technique with the conventional interference screw technique. Methods To investigate the mechanical properties, 20 in-vitro experimental tests were conducted. Synthetic dummy bone, along with fresh digital bovine tendons, as a graft, were used for experiments. Three loading steps were applied to all specimens, including a preconditioning, a main cyclic, and a pull-out loading. Results The mechanical characters of an interference screw technique using an 8 mm tendon diameter, including fixation strength, average cyclic stiffness (ACS), and average pull-out stiffness (APS) were found to be 439 ± 132 N, 10.3 ± 5.3 kN/mm, and 109 ± 40 N/mm, respectively. In the case of an interference screw using a 9 mm tendon, the fixation strength, ACS, and APS were obtained 549 ± 87 N, 10.3 ± 4.7 kN/mm, and 91 ± 13 N/mm, respectively. In parallel, the fixation strength, APS, and ACS of BASHTI technique using an 8 mm tendon were 360 ± 123 N, 3.3 ± 0.6 kN/mm, and 79 ± 27 N/mm, respectively, while, for 9 mm tendon 278 ± 103 N, 2.4 ± 1.2 kN/mm, and 111 ± 40 N/mm, were reported for fixation strength, APS, and ACS respectively when BASHTI technique was used. Conclusion About 50% of interference screw samples showed superior mechanical properties compared to BASHTI technique, but in another half of the samples, the differences were not significant (N.S.). However, due to organic advantages of BASHTI technique and lower cost, it could be used as a substitute for interference screw technique, especially where fast recovery is expected.

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Can the body slope of interference screw affect initial stability of reconstructed anterior cruciate ligament?: An in-vitro investigation

Cited by 10 publications

References 34 publications

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study

In Vitro Investigation of the Fixation Performance of a Bioabsorbable Magnesium ACL Interference Screw Compared to a Conventional Interference Screw

Comparison of mechanical properties in interference screw fixation technique and organic anterior cruciate ligament reconstruction method: a biomechanical study

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