Hybrid Femoral Fixation of Soft-Tissue Grafts in Anterior Cruciate Ligament Reconstruction Using the EndoButton CL and Bioabsorbable Interference Screws: A Biomechanical Study

Oh, Young Ho; Namkoong, Suk; Strauss, Eric J.; Ishak, Charbel; Jazrawi, Laith M.; Rosen, Jeffrey

doi:10.1016/j.arthro.2006.07.022

Cited by 34 publications

(20 citation statements)

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“…35 The EndoButton CL has a higher failure load than the original EndoButton 30 and interference screws, but shows less stiffness compared with interference screws. [53][54][55] The EndoButton CL offers significantly higher failure loads (1345 N) than the original EndoButton (644 N), bone mulch screw (977 N), LinX HT polymer hamstring tendon fastener (687 N), interference screw (562 N), and transfix device (934 N). 30 Concerns about the remote fixation point creating increasing graft elongation during cycling (bungee effect) and tunnel widening have led to the development of other soft tissue fixation alternatives.…”

Section: Soft Tissue: Femoral Sitementioning

confidence: 99%

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ACL Fixation Devices

Hapa

Barber²

2009

Sports Medicine and Arthroscopy Review

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Secure graft fixation for anterior cruciate ligament reconstruction is an important goal. Optimally, graft fixation allows for an aggressive postoperative rehabilitation program with the goals of immediate full range of motion, full weight bearing, and an early return to athletic activity. Current anterior cruciate ligament reconstruction techniques advance soft tissue grafts with or without bone plugs into the joint to replace the damaged ligament. Segments of these grafts are fixed within a bone tunnel or on the periosteum at a distance from the normal ligament attachment site. The graft fixation should be secure, allow normal tendon healing, and provide the graft construct with biomechanical properties, which approach that of the native ligament. Several different fixation devices are available for anterior cruciate ligament construction.

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Section: Soft Tissue: Femoral Sitementioning

confidence: 99%

“…62 Because of concerns about soft tissue graft slipping relative to interference screw, ''hybrid fixation'' combining an interference screw placed at the outlet to achieve greater construct stiffness with a EndoButton or EndoPearl has been described. 54,55,63,64 …”

Section: Soft Tissue: Femoral Sitementioning

confidence: 99%

ACL Fixation Devices

Hapa

Barber²

2009

Sports Medicine and Arthroscopy Review

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“…Tensile characteristics of these grafts are shown to be superior (maximum loads 2977 N [67] , 4140 N and 2353 N) to the native femur-ACL-tibia complex (2160 N) [45] with similar stiffness (Table 1) [45,[67][68][69][70][71][72][73] . Nevertheless, the weakest point of primary graft failure has turned out to be the graft fixation (Table 1).…”

Section: Graft Choice and Graft Fixationmentioning

confidence: 99%

“…Still, the dimensions of biomechanical properties range between the calculated in situ forces of the ACL [42][43][44] and its ultimate failure load [45] . In addition to sufficient failure loads of fixation techniques, fixation of the graft close to the insertion site is suggested to decrease longitudinal ("bungee") and sagittal ("windshield wiper") graft movements [66,68] . Furthermore, Oh et al [68] have found significantly increased stiffness when an interference screw was added to an extracortical endobutton fixation (307 N/mm vs 195 N/mm).…”

mentioning

confidence: 99%

“…In addition to sufficient failure loads of fixation techniques, fixation of the graft close to the insertion site is suggested to decrease longitudinal ("bungee") and sagittal ("windshield wiper") graft movements [66,68] . Furthermore, Oh et al [68] have found significantly increased stiffness when an interference screw was added to an extracortical endobutton fixation (307 N/mm vs 195 N/mm). Beyond biomechanics, clinical studies have shown good and comparable results with semitendinosus, quadriceps and bone-patellar-tendon-bone grafts for ACL reconstructions [74][75][76] .…”

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Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

Domnick

Raschke

Herbort

2016

WJO

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ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. Conflict-of-interest statement:There are no conflicts of interest to declare. Open-Access:This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/ [1] . The ACL is a central ligament of the knee. The main functional role of the ACL is to provide stability against anterior tibial translation (ATT) and internal rotation. An acute ACL rupture is a common orthopedic trauma, with an estimated incidence of 78 per 100000 persons and a mean age of 32 years in Sweden and an estimated incidence of up to 84 per 100000 persons in the United States [2,3] . A common and frequent injury mechanism is noncontact combined valgus-and internal-rotation trauma [2,4] . Therefore, ACL injuries are often associated with other ligamentous injuries, such as a (partial) rupture of the medial collateral ligament (MCL) or the menisci. In addition, compression of the lateral condyle with a bone bruise or chondral lesion is often associated with the injury due to the valgus trauma. Persistent instability of the knee may be associated with long-term degenerative lesions. Surgical treatment of the ACL in the context of other injured structures and reconstruction of the intact joint kinematics are suggested to be the keys to a good clinical outcome [5,6] . ANATOMYThe ACL has its origin at the medial area of the lateral femoral condyle and inserts into the center of the eminentia of the tibia plateau next to the anterior horn of the lateral meniscus. The structure of the ACL has been described as two functional bundles: The anteromedial (AM) and the posterolateral (PL) bundle [7] . These two bundles have been associated with different roles in anteroposterior and complex-rotational stabilization of the joint [8][9][10] . The femoral origin was described as oval shaped with a longitudinal diameter of 18 mm and a width of approximately 11 mm [11,12] . ...

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Biomedical coatings on polyethylene terephthalate artificial ligaments

Chen

2014

J Biomedical Materials Res

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This review comprehensively covers research conducted to enhance polyethylene terephthalate (PET) artificial ligament osseointegration in the bone tunnel. These strategies, using biocompatible or bioactive coatings, had a positive effect in promoting PET ligament osseointegration by increasing bone formation and decreasing fibrous scar tissue at the ligament-to-bone interface. The improved osseointegration can be translated into a significant increase in the biomechanical pull-out loads. However, the load-to-failure of coated ligament is far lower than that of native ACL. Coatings to promote intra-articular ligamentization are also discussed in this study. Collectively, our investigations may arouse further study of the biological coating of PET artificial ligaments in order to effectively enhance ligament osseointegration and promote artificial ligament ligamentization.

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Hybrid Femoral Fixation of Soft-Tissue Grafts in Anterior Cruciate Ligament Reconstruction Using the EndoButton CL and Bioabsorbable Interference Screws: A Biomechanical Study

Cited by 34 publications

References 28 publications

ACL Fixation Devices

ACL Fixation Devices

Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

Biomedical coatings on polyethylene terephthalate artificial ligaments

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