In vitro biomechanical testing of anterior cruciate ligament reconstruction: Traditional versus physiologically relevant load analysis

Trump, M. E.; Palathinkal, Darren M.; Beaupré, Lauren A; Otto, David; Leung, P.C.; Amirfazli, Alidad

doi:10.1016/j.knee.2010.04.011

Cited by 15 publications

(17 citation statements)

References 34 publications

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“…A lower stiffness can, therefore, increase the displacement associated with anterior translation and may result in an unstable knee. There is consensus in the literature that the EndoButton have less stiffness than the Bio Cross-Pin (Milano et al, 2006;Rodríguez et al, 2014;Trump et al, 2011). Considering the energy that the femur-graft complex has absorbed up to the point of fixation failure, there was not differences between the both techniques evaluated.…”

Section: Discussionmentioning

confidence: 93%

Biomechanical performance of Bio Cross-Pin and EndoButton for ACL reconstruction at femoral side: a porcine model

et al. 2016

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Introduction: The method of graft fixation is critical in anterior cruciate ligament (ACL) reconstruction surgery. Success of surgery is totally dependent on the ability of the implant to secure the graft inside the bone tunnel until complete graft integration. The principle of EndoButton is based on the cortical suspension of the graft. The Cross-Pin is based on graft expansion. The aim of this study was to evaluate the biomechanical performance of EndoButton and Bio Cross-Pin to fix the hamstring graft at femoral side of porcine knee joints and evaluate whether they are able to support of loading applied on graft during immediate post-operative tasks. Methods: Fourteen ACL reconstructions were carried out in porcine femurs fixing superficial flexor tendons with Titanium EndoButton (n = 7) and with 6 × 50 mm HA/PLLA Bio Cross-Pin (n = 7). A cyclic loading test was applied with 50-250 N of tensile force at 1 Hz for 1000 cycles. The displacement was measured at 20, 100, 500 and 1000 load cycles to quantify the slippage of the graft during the test. Single-cycle load-to-failure test was performed at 50 N/mm to measure fixation strength. Results: The laxity during cyclic loading and the displacement to failure during single-cycle test were lower for the Bio Cross-Pin fixation (8.21 ± 1.72 mm) than the EndoButton (11.20 ± 2.00 mm). The Bio Cross-Pin (112.22 ± 21.20 N.mm -1 ) was significantly stiffer than the EndoButton fixation (60.50 ±10.38 N.mm -1 ). There was no significant difference between Bio Cross-Pin (failure loading: 758. 29 ± 188.05 N; yield loading: 713.67 ± 192.56 N) and EndoButton strength (failure loading: 672.52 ± 66.56 N; yield loading: 599.91 ± 59.64 N). Both are able to support the immediate post-operative loading applied (445 N). Conclusion: The results obtained in this experiment indicate that the Bio Cross-Pin technique promote stiffer fixation during cyclic loading as compared with EndoButton. Both techniques are able to support the immediate post-operative loading applied.

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Section: Discussionmentioning

confidence: 93%

Biomechanical performance of Bio Cross-Pin and EndoButton for ACL reconstruction at femoral side: a porcine model

et al. 2016

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“…By the use of 3D motion analysis and a force plate, the net moments of force acting on the entire knee can be measured. A recent study by Trump et al estimates the loads applied on the knee of a 70-kg individual during walking, jogging, and stair to be 150 N, 250 N, and 340 N, respectively (Trump et al, 2011). Pivoting places a load of approximately 0.3x body weight on the knee (not yet published data from the authors PHD).…”

Section: Discussionmentioning

confidence: 99%

“…The elongation of the graft construct was recorded during the cyclic test. Finally, the graft/femur complex was tested to failure (Weimann et al, 2006;Lehmann et al, 2009;Trump et al, 2011). Stiffness of the graft/femur complex and ultimate failure load was documented.…”

Section: Tensile Testingmentioning

confidence: 99%

Mechanical stability of the femoral fixation for single‐ and double‐bundle ACL reconstruction in an in vitro experimental model

Bohn

Vestergaard

Dalstra

et al. 2011

Scandinavian Med Sci Sports

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Anterior cruciate ligament ACL reconstruction using the double-bundle (DB) technique is gaining popularity. A possible weak link in the DB technique could be that two tendon grafts of smaller diameters are used. The purpose of this study was to test different femoral fixation methods and graft diameters representing single-bundle (SB) and DB ACL reconstructions and compare their biomechanical properties. We hypothesized that SB 6-mm graft constructs had inferior biomechanical properties than SB 9-mm grafts or DB 2 × 6-mm grafts. Furthermore, we hypothesized that interference (IF) screw fixation would demonstrate less elongation and a higher stiffness than Endobutton (Smith & Nephew®, Inc., Andover, Massachusetts, USA) fixation (EBF). We performed an in vitro study using porcine knees and extensor tendons. The mechanical test consisted of a cyclic test followed by a load-to-failure test. We found that 6-mm graft constructs had an ultimate failure load that was up to 40% less than both the 9-mm and 2 × 6-mm graft constructs, despite the fixation method (P-values ≥ 0.004). Comparing fixation methods, EBF was superior to IF concerning maximum load to failure (P < 0.001); IF resulted in a higher stiffness of the femur/graft complex than the EBF (P < 0.001) but no significant difference in elongation between fixation methods. Since the two graft strands are subjected to different loads in different knee flexion angles, the reduced strength of the individual graft strands in DB ACL reconstruction could be a concern.

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“…The graft was pre-tensioned with a 10 N load for 60 seconds, 19 followed by the 50 mm/min speed test 20 until fixation failure. For the analysis of the results, we used the system rigidity (R R ) by the secant method for light loads (toe-region), the R R by the ordinary least squares method (tangent), and load to system failure (yield load), following the Pearson correlation coefficient 10 and the tension for failure (σR).…”

Section: Methodsmentioning

confidence: 99%

Fixação do enxerto do ligamento cruzado anterior no polo tibial: Análise biomecânica de três métodos

et al. 2019

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Objective Comparative biomechanical analysis of tibial fixation strength for ligament reconstruction with interference screw compared with screw post and washer, and compared with the associated fixation of both methods (hybrid fixation). Method A total of 54 specimens were used (porcine tibias and bovine flexor digital tendons), which were divided into three groups with fixation types similar to those used in anterior cruciate ligament (ACL) reconstruction: 1) fixation with interference screw; 2) fixation with screw post and toothed washer over knot and suture strand; and )- fixation with screw post and washer combined with interference screw (hybrid fixation). The analyses were performed through pull-out biomechanical tensile tests to determine the stiffness and load to system failure (yield load). Results The hybrid fixation group presented a significantly higher final stiffness (59.10 ± 3.45 N/mm) in comparison to the other groups ( p < 0.05) and a higher yield load (581.34 ± 33.48 N) compared to the interference screw group ( p < 0.05). Conclusion Hybrid fixation had biomechanical advantages over the bovine digital flexor graft fixation system in swine tibia during tensile tests.

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In vitro biomechanical testing of anterior cruciate ligament reconstruction: Traditional versus physiologically relevant load analysis

Cited by 15 publications

References 34 publications

Biomechanical performance of Bio Cross-Pin and EndoButton for ACL reconstruction at femoral side: a porcine model

Biomechanical performance of Bio Cross-Pin and EndoButton for ACL reconstruction at femoral side: a porcine model

Mechanical stability of the femoral fixation for single‐ and double‐bundle ACL reconstruction in an in vitro experimental model

Fixação do enxerto do ligamento cruzado anterior no polo tibial: Análise biomecânica de três métodos

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