The Influence of Supplementary Tibial Fixation on Laxity Measurements after Anterior Cruciate Ligament Reconstruction with Hamstring Tendons in Female Patients

Abstract

Supplementary tibial fixation in female patients undergoing anterior cruciate ligament reconstruction with hamstring tendon graft in addition to a single-size screw significantly improves laxity measurements and clinical stability assessment 2 years after surgery. However, this improvement is at the cost of increased kneeling pain.

Anterior Cruciate Ligament Reconstruction Using Autogenous Doubled Gracilis and Semitendinosus Tendons With GTS Sleeve and Tapered Screw Tibial Fixation

“…1,2,10 If the surgeon feels that there was inadequate insertion torque during the insertion of the tapered screw or the patient has soft bone, then we recommend that supplemental tibial fixation be used. 10 Depending on the graft length, the protruding DGST tendons can be stapled below the tibial tunnel using a small barbed staple (Smith & Nephew Orthopaedics, Memphis, TN), or the sutures can be tied around a x-small nonbarbed staple or tibial fixation post (Smith & Nephew Endoscopy) (Fig. 6).…”

“…However, tibial fixation of hamstring tendon anterior cruciate ligament (ACL) grafts remains problematic. 1,2,8,10,14,15,18 Problems with tibial fixation result primarily from the lower bone mineral density of the proximal tibia, the fact that tibial fixation devices must resist shear forces applied parallel to the axis of the tibial bone tunnel, and the longer time required for soft tissue grafts to heal to bone. 1,2,9,10,16 Tibial fixation using screws and washers that anchor to the tibial cortex can address many of these issues; however, these implants are often prominent and often cause local skin irritation and pain requiring a second operation for removal.…”

“…1,2,8,10,14,15,18 Problems with tibial fixation result primarily from the lower bone mineral density of the proximal tibia, the fact that tibial fixation devices must resist shear forces applied parallel to the axis of the tibial bone tunnel, and the longer time required for soft tissue grafts to heal to bone. 1,2,9,10,16 Tibial fixation using screws and washers that anchor to the tibial cortex can address many of these issues; however, these implants are often prominent and often cause local skin irritation and pain requiring a second operation for removal. 15 Intratunnel tibial fixation using interference screws avoids the problem of prominent hardware; however, laboratory biomechanical studies have shown that the tensile properties of soft tissue grafts fixed with interference screws is highly dependent on bone mineral density, and this fixation technique often results in low initial fixation strength and slippage under cyclic loading.…”

“…15 Intratunnel tibial fixation using interference screws avoids the problem of prominent hardware; however, laboratory biomechanical studies have shown that the tensile properties of soft tissue grafts fixed with interference screws is highly dependent on bone mineral density, and this fixation technique often results in low initial fixation strength and slippage under cyclic loading. 1,2,8,10,14,15 The GTS System (Smith & Nephew Endoscopy) is a new intratunnel tibial fixation technique that positions a PLLA tapered, fine pitch screw (GTS Tapered Screw) concentrically within a 4-strand soft tissue graft. The screw features a tapered design and shorter thread distance, which enhances compression of the soft tissue graft in cancellous bone.…”

Comparison of Bioabsorbable Suture Anchor Fixation on the Tibial Side for Anterior Cruciate Ligament Reconstruction Using Free Soft Tissue Graft: Experimental Laboratory Study on Porcine Bone

“…Biomechanical studies showed that interference screws combined with additional indirect distal hamstring tendon fixation techniques can withstand much higher tearing forces than one type of fixation alone 4,5,6,7. However, additional metallic fixation devices (e.g., spike washers, post screws, and metal buttons) cause irritation of the soft tissue around the tibial cortical area, thus causing limitations such as metal removal 8,9. Therefore, we hypothesized that using BISs simultaneously with additional bioabsorbable suture anchor (BSA) devices could augment early fixation.…”