Tibial Fixation of Anterior Cruciate Ligament Allograft Tendons: Comparison of 1-, 2-, and 4-Stranded Constructs

Background In sum, 1-, 2-, and 4-stranded allografts are used for soft tissue anterior cruciate ligament reconstruction; however, the fixation properties of fixation devices are not well assessed. Hypothesis There are no differences in the biomechanical characteristics of 1 (Achilles)-, 2 (posterior...

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Published in:The American journal of sports medicine 2009-08, Vol.37 (8), p.1531-1538
Main Authors: Park, Daniel K., Fogel, Harold A., Bhatia, Sanjeev, Bach, Bernard R., Gupta, Aman, Shewman, Elizabeth F., Wang, Vincent, Verma, Nikhil, Provencher, Matthew T.
Format: Article
Language:English
Subjects:
Animals
Anterior Cruciate Ligament - surgery
Anterior Cruciate Ligament - transplantation
Biological and medical sciences
Biomechanical Phenomena
Biomechanics
Biomechanics. Biorheology
Bone Screws
Bone surgery
Cadaver
Diseases of the osteoarticular system
Fundamental and applied biological sciences. Psychology
Ligaments
Medical sciences
Orthopedic Procedures
Sports injuries
Sports medicine
Swine
Tendons
Tibia - surgery
Tissues, organs and organisms biophysics
Transplantation, Homologous
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Summary:Background In sum, 1-, 2-, and 4-stranded allografts are used for soft tissue anterior cruciate ligament reconstruction; however, the fixation properties of fixation devices are not well assessed. Hypothesis There are no differences in the biomechanical characteristics of 1 (Achilles)-, 2 (posterior tibialis)-, and 4 (semitendinosus)-stranded allograft tibial fixation. Study Design Controlled laboratory study. Methods Sixty-three fresh-frozen porcine tibiae were used to evaluate the fixation of 1-, 2-, and 4-stranded human tendon allografts (Achilles, posterior tibialis, and semitendinosus) with 3 fixation devices (Delta, Intrafix, and Calaxo screws). With use of a materials testing system, each graft was subjected to 500 cycles of loading (50-250 N, 0.75 mm/sec) to determine displacement and cyclic stiffness, followed by a monotonic failure test (20 mm/min) to determine maximum load and pullout stiffness. Results For each graft type, there were no significant biomechanical differences between fixation devices. However, the 1-stranded graft (Achilles) construct demonstrated significantly higher mean displacement (3.17 ± 1.62 mm), lower cyclical stiffness (156 ± 25 N/mm), lower load to failure (479 ± 87 N), and lower pullout stiffness (140 ± 28 N/mm). In comparison with the 2-stranded graft (posterior tibialis), the 4-stranded graft (semitendinosus) exhibited lower displacement (0.86 ± 0.44 to 1.12 ± 0.51 mm) and higher ultimate failure load (832 ± 255 to 656 ± 168 N). Numerous differences in fixation properties were noted when comparing a device to each of the 3 grafts. Conclusion The 1-stranded allograft demonstrated inferior biomechanical tibial fixation properties when compared with 2 (posterior tibialis)- and 4 (semitendinosus)-stranded allograft constructs for all fixation devices tested. Clinical Relevance This study demonstrated that not all tibial fixation devices are designed to adequately accommodate different types of anterior cruciate ligament allografts. Biomechanical evidence suggests that caution is warranted when using an Achilles allograft fixated solely with an interference device.
ISSN:0363-5465
1552-3365
DOI:10.1177/0363546509332504