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

Abstract

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.

Functional Outcomes of Anterior Cruciate Ligament Reconstruction Using Titanium Adjustable Loop Button and Poly-L-co-DL-Lactic Acid-Beta Tricalcium Phosphate (PLDLA-bTCP) Interference Screws: A Single-Center, Retrospective, Observational Study

“…Aperture fixation devices include interference screws. Although there is no set pattern of fixation in ACL surgeries, most surgeons prefer a combination of suspensory and aperture fixation [ 10 ].…”

Sheathed fixation improves BASHTI technique in an anterior cruciate ligament reconstruction

“…By using the core bone plug, the graft tissue compresses against the tunnel wall and the friction created between the tunnel wall and graft tissue prevents graft tissue from slipping out of the tunnel. 10 , 11 , 13 , 14 It also uses the hamstring tendon as graft tissue which does not have the aforementioned problems observed in the patellar graft. 9 In this method, the tunnel site in the tibia and femur is cut by a cannulated drill bit, which can be a custom made drill bit that removes the core bone from the tunnel with a minimum gap.…”

“…10 , 11 , 13 , 14 Following the graft insertion inside the tunnel, the core bone is pushed back to the tunnel to compress the graft against the tunnel wall. 10 , 11 , 13 , 14 …”

“…9 In this method, the tunnel site in the tibia and femur is cut by a cannulated drill bit, which can be a custom made drill bit that removes the core bone from the tunnel with a minimum gap. 10,11,13,14 Following the graft insertion inside the tunnel, the core bone is pushed back to the tunnel to compress the graft against the tunnel wall. 10,11,13,14 The first study about this technique showed that there is no significant difference between the fixation strength of BASHTI groups and interference groups.…”

Current strategies for enhancement of the bioactivity of artificial ligaments: A mini-review

“…Interference screws fixation is practically adopted in tendon transfer and is reported with high satisfaction rates and low complication rates [ 10 ]. However, as commercial interference screw products like Biosure Regenesorb™ are economically costly, research regarding organic implant-less techniques for ACL reconstruction, like Bone and Site Hold Tendon Inside (BASHTI) technique, are considered as a substitute for interference screw fixation, especially where fast recovery is expected [ 11 ]. Adjustable fixation devices like Ultrabutton™, on the other hand, focus on providing fixation for ligamentous implantation by string-loops and a metal button.…”