Core bone diameter in an organic implant-less technique affecting the biomechanical properties of the anterior cruciate ligament fixation; an in-vitro study

Mohseni, Mahdi; Nourani, Amir; Korani, Hossein; Moeinnia, Hadi; Borjali, Amirhossein; Ghias, Narges; Chizari, Mahmoud

doi:10.1101/2021.07.12.452098

Cited by 4 publications

(4 citation statements)

References 19 publications

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“…Furthermore, an experimental study concluded that using a sheathed core bone plug makes the insertion process more feasible and improves the CBPF or BASHTI technique more reliable [25]. The CBPF technique has also been used to apply the biceps tenodesis or long head biceps repair, and the results were comparable with other conventional biceps tenodesis methods [26, 27].…”

Section: Introductionmentioning

confidence: 99%

“…The effect of geometry parameters such as tunnel size, core bone plug diameter, and tendon diameter on the strength of CBPF has been investigated using finite element models and experimental tests [20][21][22][23][24]. The results showed that the mode of the tendon failure and fixation strength were highly influenced by the tendon compression and core bone diameter.…”

Section: Introductionmentioning

confidence: 99%

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Bone density may affect primary stability of anterior cruciate ligament reconstruction when organic core bone plug fixation technique used

et al. 2022

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Purpose Core Bone Plug Fixation (CBPF) technique is an implant-less methodology for ACL reconstruction. This study investigates the effect of bone density on CBPF stability to identify the bone quality that is likely to benefit from this technique. Methods Artificial blocks with 160 (Group 1), 240 (Group 2), and 320 (Group 3) kg/m3 densities were used to simulate human bone with diverse qualities. These groups are representative of the elderly, middle age and young people, respectively. A tunnel was made in each test sample using a cannulated drill bit which enabled harvesting the core bone plug intact. Fresh animal tendon grafts were prepared and passed through the tunnel, so the core bone was pushed in to secure the tendon. The fixation stability was tested by applying a cyclic load following by a pullout load until the failure occurred. The selected group was compared with interference screw fixation technique as a gold standard method in ACL reconstruction. Results The Group 2 stiffness and yield strength were significantly larger than Group 1. The graft slippage of Group 1 was significantly less than Group 3. The ultimate strengths were 310 N and 363 N, in Groups 2 and 3, significantly larger than that of Group 1. The ultimate strength in fixation by interference screw was 693.18 N, significantly larger than the bone plug method. Conclusions The stability of CBPF was greatly affected by bone density. This technique is more suitable for young and middle-aged people. With further improvements, the CBPF might be an alternative ACL reconstruction technique for patients with good bone quality. Clinical relevance The CBPF technique offers an implant-less organic ACL reconstruction technique with numerous advantages and likely would speed up the healing process by using the patient’s own bones and tissues rather than any non-biologic fixations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bone density may affect primary stability of anterior cruciate ligament reconstruction when organic core bone plug fixation technique used

et al. 2022

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“…5 ). The fixation failure was monitored, either considering an elongation of more than 10 mm or a visible tendon rupture [ 14 ]. To simplify the fixation geometrical parameters (i.e.…”

Section: Methodsmentioning

confidence: 99%

Effect of the core bone engaged length on the BASHTI fixation strength, an in-vitro study on bovine tendons using identical-density surrogate bones

Moeinnia

Nourani

Mohseni

et al. 2023

BMC Musculoskelet Disord

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Background BASHTI is an implant-less anterior cruciate ligament (ACL) reconstruction technique, which resolves the problems caused by implants such as interference screws. This study aims to investigate the effect of the drill bit and tendon’s diameter on the Core Bone Engaged Length (CBEL) and the fixation strength. CBEL is the length of core bone which has a full engagement with both tunnel and graft at the same time. Methods 60 in-vitro tests were conducted for 6, 7, 8, and 9 mm tendon sizes with a 10 mm bone tunnel. In this study bovine tendons and dummy bone blocks were used to model the fixation. Drill bits were used to extract the core bone for securing the auto-graft. A three-stage tensile test including a force-controlled cyclical preloading of 10–50 N with a frequency of 0.1 Hz for 10 cycles, followed by the main force-controlled cyclical loading of 50–200 N with a frequency of 0.5 Hz for 150 cycles, and immediately a displacement-controlled single cycle pull-out load with a rate of 20 mm/min were carried out to discover the fixation strength of each sample. Results The 6 mm group had the greatest CBEL. However, all cases in this group failed in loadings below 200 N, which is the minimum required strength after ACL reconstruction. The fixation strength of cases with more than 200 N fixation strength for 7, 8, and 9 mm tendon diameters were 275 ± 42, 330 ± 110, and 348 ± 93 N, respectively, showing insignificant difference between groups (P-value = 0.45). Nevertheless, CBELs for these groups were 16.6 ± 3.4, 9.6 ± 2.4, and 11.7 ± 3.8 mm, respectively, implying a significant increase in CBEL in the 7 mm group than that for 8 and 9 mm groups (P-value = 0.002 and 0.049, respectively). Conclusion Results showed that CBEL could assess the quality of BASHTI technique. However, CBEL was an inverse function of tendon compression, so it was not an independent parameter to determine BASHTI strength. Also, the CBEL of 7 mm group which fulfilled the 200 N threshold was higher than that of 8 and 9 mm groups, so its healing process speed may be higher, which is recommended for a future study in this field.

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“…Their results showed that BASHTI technique is more suitable for individuals with high density bones, 240 and 320 kg/m 3 , which is related to the young and middle-aged patients. Furthermore, due to the notable impact of geometrical variations on mechanical properties, 13 , 17 – 19 the geometrical parameters (i.e. tendon and core bone diameters) on the fixation strength of BASHTI technique were investigated.…”

Section: Introductionmentioning

confidence: 99%

Sheathed fixation improves BASHTI technique in an anterior cruciate ligament reconstruction

Borjali

Farrahi

Chizari

2023

Proc Inst Mech Eng H

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Bone and Site Hold Tendon Inside (BASHTI) technique is an implant-less surgical methodology used for anterior cruciate ligament (ACL) reconstruction. It has some clinical advantages, such as speeding up the healing process. Since the force required to insert the core bone inside the tunnel may damage the core bone and affect the fixation process, the study aims to investigate the strength of fixation of BASHTI technique using proposed sheathed core bones. Experimental tests were performed to evaluate the biomechanical strength of the fixation. Synthetic bone combined with bovine tendons as a graft was used. Polymers were used to create the sheath for mechanical testing. The results showed that fixation strength and stiffness in PTFE sheath with 0.1 mm were 343.86 N and 114.62 N/mm and in PVC sheath with similar thickness, 235.95 N, and 93.36 N/mm. Subsequently, 0.2 mm PTFE sheaths were tested in two different sections: incomplete fixation and complete fixation. The strength and stiffness of the first section were 221.6 N and 66.99 N/mm and for the second section 420.02 N and 126.16 N/mm. Using sheath facilitates the fixation process in BASHTI technique. The 0.1 mm PTFE sheath and 0.2 mm PTFE sheath with complete fixation provide higher fixation strength than other groups. The outcome showed that engaged length has a direct effect on the fixation strength. The BASHTI technique offers an implant-less organic ACL reconstruction method that can improve the fixation method and speed up the healing process.

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Core bone diameter in an organic implant-less technique affecting the biomechanical properties of the anterior cruciate ligament fixation; an in-vitro study

Cited by 4 publications

References 19 publications

Bone density may affect primary stability of anterior cruciate ligament reconstruction when organic core bone plug fixation technique used

Bone density may affect primary stability of anterior cruciate ligament reconstruction when organic core bone plug fixation technique used

Effect of the core bone engaged length on the BASHTI fixation strength, an in-vitro study on bovine tendons using identical-density surrogate bones

Sheathed fixation improves BASHTI technique in an anterior cruciate ligament reconstruction

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