The evolgate: a method to improve the pullout strength of interference screws in tibial fixation of anterior cruciate ligament reconstruction with doubled gracilis and semitendinosus tendons

Ferretti, Andrea; Conteduca, Fabio; Morelli, Federico; Ticca, Lorenzo; Monaco, Edoardo

doi:10.1016/j.arthro.2003.09.003

Cited by 26 publications

(25 citation statements)

References 10 publications

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“…We used Swing-Bridge (Citieffe, Bologna, Italy) for femoral fixation and Evolgate (Citieffe) for tibial fixation. [11][12][13] In addition to the ACL reconstruction procedure, we performed 2 partial medial meniscectomies for a complex tear of the posterior horn and for a bucket-handle lesion and 1 partial lateral meniscectomy for a radial lesion of the posterior horn of the lateral meniscus.…”

Section: Surgical Techniquementioning

confidence: 99%

Double-Bundle Anterior Cruciate Ligament Reconstruction

et al. 2007

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Section: Surgical Techniquementioning

confidence: 99%

Double-Bundle Anterior Cruciate Ligament Reconstruction

et al. 2007

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“…In our study we used very strong and stiff fixation devices [2,8,9] and we found a slight femoral (3%) and moderate tibial (11%) bone tunnel enlargement in the control group and a significantly higher femoral (10.4%) and tibial (17.7%) tunnel widening in the study group. Although all these values, even calculating the cross sectional area of the tunnels are lower than the 33% reported in a MRI study by Fules et al [11], and to the suggested threshold of 50% which is considered to be significant for tunnel enlargement, the difference found in the two groups seems to be noteworthy, and probably attributable to the different postoperative rehabilitation used.…”

Section: Discussionmentioning

confidence: 96%

The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study

Vadalà¹,

Iorio²,

Carli³

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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The mechanism of bone tunnel enlargement following anterior cruciate ligament (ACL) reconstruction is not yet clearly understood. Many authors hypothesized that aggressive rehabilitation protocols may be a potential factor for bone tunnel enlargement, especially in reconstructions performed with hamstrings autograft. The purpose of this study was to evaluate the effect of a brace free rehabilitation on the tunnel enlargement after ACL reconstruction using doubled semitendinosus and gracilis tendons (DGST): our hypothesis was that early post-operative knee motion increase the diameters of the tibial and femoral bone tunnels. Forty-five consecutive patients undergoing ACL reconstruction for chronic ACL deficiency were selected. All patients were operated by the same surgeon using autologous DGST and the same fixation devices. Patients with associated ligaments injuries and or severe chondral damage were excluded. The patients were randomly assigned to enter the control group (group A, standard post-operative rehabilitation) and the study group (group B, brace free accelerated rehabilitation). A CT scan was used to exactly determine the diameters of both femoral and tibial tunnels at various levels of lateral femoral condyle and proximal tibia, using a previously described method [17]. Measurements were done by an independent radiologist in a blinded fashion the day after the operation and at a mean follow-up of 10 months (range 9-11). Statistical analysis was performed using paired t-test. The mean femoral tunnel diameter increased significantly from 9.04 +/- 0.05 (post-operative) to 9.30 +/- 0.8 mm (follow-up) in group A and from 9.04 +/- 0.03 to 9.94 +/- 1.12 mm in group B. The mean tibial tunnel diameter increased significantly from 9.03 +/- 0.04 to 10.01 +/- 0.80 mm in group A and from 9.04 +/- 0.03 to 10.60 +/- 0.78 mm in group B. The increase in femoral and tunnel diameters observed in the study group was significantly higher than that observed in the control group. Our results suggest that bone tunnel enlargement after ACL reconstruction using hamstrings autograft can be increased by an accelerated, brace free, rehabilitation protocol.

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“…We selected the Evolgate because it is one of the strongest and stiffest tibial fixation devices [11,12]. A second issue is the length of the tunnel, which in the ovine model is shorter than in the human tibia.…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies [10][11][12], we tested the Evolgate (Citieffe, Bologna, Italy), a fixation device designed to improve the biomechanical properties of the interference screw by reinforcing the walls of the tibial tunnel with an involute, a sort of spiral. The Evolgate is composed of three components made in a titanium alloy: an involute (21 mm in length, 10 mm in diameter) with a spike positioned at one extremity, a screw (20 mm long, 9 mm diameter) and a washer.…”

Section: Introductionmentioning

confidence: 99%

“…On the basis of several biomechanical tests conducted with both pull out and cyclic loading, the biomechanical properties of the Evolgate were initially found to be better than other aperture fixation devices such as the interference screw [10,12] and Intrafix (DePuy-Mitek) [11]. The purpose of this study was to evaluate, in an extraarticular ovine model, how 4 and 12-weeks of implantation affect the strength of a tendon graft fixed to bone with the Evolgate.…”

Section: Introductionmentioning

confidence: 99%

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How four and twelve weeks of implantation affect the strength and stiffness of a tendon graft securely fixed in a bone tunnel: a study of Evolgate fixation in an extra-articular model ovine model

Ferretti

Monaco

Labianca

et al. 2006

J Orthopaed Traumatol

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Healing of a tendon graft to a bone tunnel is slower than the healing of a bone plug. Therefore, the device chosen for hamstring fixation may need to maintain its strength and stiffness longer than the device chosen for bone-tendon-bone fixation. We evaluated, in an extraarticular ovine model, how 4 and 12 weeks of implantation affect the strength of a tendon graft fixed to bone with the Evolgate. The long digital extensor tendon was transplanted and fixed with the Evolgate into a 30-mm long, 8 mm diameter bone tunnel drilled in the tibial metaphysis of both posterior limbs of 15 skeletally mature Suffolk sheep. Immediately after implantation, and 4 and 12 weeks later, biomechanical cyclic load tests in 50 N increments were performed until failure to evaluate the ultimate failure load (UFL). Histological analysis was also performed at 4 and 12 weeks. Biomechanical tests revealed a UFL of 339±120 N at time 0, and increases to 635±19 N (4 weeks) and to 867±80 N (12 weeks). The differences between all 3 groups were significant (p<0.001, paired t test). The histological evaluation showed a layer of cellular, fibrous tissue between the tendon and the bone, along the length of the bone tunnel; this layer progressively matured and reorganized during the healing process. The collagen fibers that attached the tendon to the bone resembled Sharpey's fibers. The strength of the interface significantly and progressively increased between weeks 4 and 12 after transplantation, and was associated with a degree of bone ingrowth noted histologically. The use of the Evolgate seems not to interfere with the bone ingrowth after implantation, allowing an improvement in strength of the bonetendon-device complex.

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The evolgate: a method to improve the pullout strength of interference screws in tibial fixation of anterior cruciate ligament reconstruction with doubled gracilis and semitendinosus tendons

Cited by 26 publications

References 10 publications

Double-Bundle Anterior Cruciate Ligament Reconstruction

Double-Bundle Anterior Cruciate Ligament Reconstruction

The effect of accelerated, brace free, rehabilitation on bone tunnel enlargement after ACL reconstruction using hamstring tendons: a CT study

How four and twelve weeks of implantation affect the strength and stiffness of a tendon graft securely fixed in a bone tunnel: a study of Evolgate fixation in an extra-articular model ovine model

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