Document Title: Nagarkatti-AJSM-Jan01

Article Title: Mechanical evaluation of a soft-tissue interference screw in free tendon anterior cruciate ligament graft fixation

Author: Durgesh G. Nagarkatti, Brian P. McKeon, Brian S. Donahue, John P. Fulkerson.

Publication: The American Journal of Sports Medicine

ISSN: 03635465

Date: January-February 2001.

(Figures included. Reference-denoting numbers appear in the same point size as document text.)

Volume: 29

Issue: 1

Pages: 67-71

Key Words: Knee, surgical, tendon, graft, fixation, bone.

 

This article discusses bioabsorbable interference screws, and compares hamstring-group-tendon (DLSTG) ACL-graft-anchorage methodologies with those used in the context of the traditional patellar-tendon autograft.

ABSTRACT

 

In this study of bioabsorbable screw fixation of free tendon grafts used in anterior cruciate ligament reconstruction, we performed load-to-failure and cyclic loading of tendon fixation in porcine bone. Bone density measurements from dual photon absorptometry scans were obtained to correlate bone density with fixation failure. The average density of porcine bone (1.42 grams per square centimetre) is similar to that of young human bone (1.30 grams per square centimetre) and significantly higher than that of elderly human cadaveric bone specimens (0.30 grams per square centimetre). Cyclic loading was performed on free tendon grafts fixed with a bioabsorbable screw alone and on grafts fixed with a bioabsorbable screw and an anchor (polylactic acid ball or cortical bone disk). Stiffness of fixation increased substantially with the addition of a cortical bone disk anchor or polylactic acid ball compared with the interference screw alone. Tensile fixation strength of central quadriceps free tendon and hamstring tendon grafts were significantly superior in porcine bone of density similar to young human bone than in elderly human cadaveric bone. The bioabsorbable interference screw yielded loads at failure comparable with traditional bone-tendon-bone and hamstring tendon fixation when controlled for bone density. The addition of a cortical bone disk anchor provided the most optimal fixation of free tendon with the bioabsorbable screw and reduced slippage with cyclic loading to a very low level.

 

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