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Teng Y, Jia G, Lu F, Da L, Teng F, Zhao L, Geng B, Yun X, Han H, Xia Y. Biomechanical comparison of proximal, distal, and anatomic tibial tunnel for transtibial posterior cruciate ligament reconstruction. Proc Inst Mech Eng H 2023; 237:104-112. [PMID: 36426874 DOI: 10.1177/09544119221135935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
No consensus has been reached on the optimal position of PCL tibial tunnel. The purpose of this study was to compare the biomechanical properties of proximal, distal and anatomic tibial tunnel in transtibial posterior cruciate ligament reconstruction. An in-vitro model of transtibial posterior cruciate ligament reconstruction was simulated using porcine tibias and bovine extensor tendons. Two models of biomechanical testing, load-to-failure loading, and cyclic loading, were performed in this study. The load-to-failure loading found that distal tibial tunnel resulted in greater ultimate load and yield load than the anatomic and proximal tunnel group (p < 0.05), whereas there were no significant differences in mean tensile stiffness among three groups (p > 0.05). The cyclic loading found no differences in the graft displacement at 250, 500, and 1000 cycles among three groups (p > 0.05). It was found that distal tibial tunnel showed superior ultimate load and yield load in load-to-failure loading testing compared with proximal and anatomic tibial tunnels, whereas no significant difference was found in terms of the mean displacement of the survived grafts in cyclic loading testing among three groups.
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Affiliation(s)
- Yuanjun Teng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Gengxin Jia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Fan Lu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Lijun Da
- Department of Oncology, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China
| | - Fei Teng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Lianggong Zhao
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Bin Geng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Xiangdong Yun
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Hua Han
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, Gansu, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, Gansu, People's Republic of China
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Yang W, Li C, Ji X, Yao M, Hong J, Qu Z, Liu A, Wu H. Synergistic Effect of Reverse Drilling and Bone Dust on Femoral Tendon-Bone Healing After Anterior Cruciate Ligament Reconstruction in a Rabbit Model. Am J Sports Med 2022; 50:3844-3855. [PMID: 36326437 DOI: 10.1177/03635465221129267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries and bone tunnel enlargement (BTE) after ACL reconstruction (ACLR) remain frequent issues. Bone dust (BD) produced by tunnel preparation with osteogenic ability and reverse drilling (RD), an easy compaction technique, make it accessible to enhance tendon-bone healing in the clinic. HYPOTHESIS RD and BD synergistically promote tendon-bone healing by improving peritunnel bone and preventing BTE in femurs. STUDY DESIGN Controlled laboratory study. METHODS In total, 96 New Zealand White rabbits underwent ACLR. The semitendinosus tendon was freed before medial parapatellar arthrotomy. After the native ACL was transected, bone tunnels were prepared through the footprint of the native ACL. All animals were randomly assigned to 1 of 4 groups according to different tunnel preparation methods: group 1 (irrigation after extraction drilling [ED]; control group), group 2 (irrigation after RD), group 3 (no irrigation after ED), and group 4 (no irrigation after RD). BD was harvested by irrigating tunnels and was characterized by morphology and size. The specimens underwent microarchitectural, histological, and biomechanical evaluations at 4, 8, and 12 weeks postoperatively. RESULTS Micro-computed tomography demonstrated more peritunnel bone and less BTE in the femurs of group 4 compared with the other groups. Histologically, BD possessed osteogenic activity in bone tunnels postoperatively. Meanwhile, group 4 regenerated a higher amount of the tendon-bone interface and more peritunnel bone than group 1. Biomechanically, group 4 showed higher failure loads and stiffness than group 1. However, peritunnel bone loss, active osteoclasts, and significant BTE were found in the femurs of group 1 and group 3 at 12 weeks postoperatively, while no strong correlation was found between BTE and inflammatory cytokines. Scanning electron microscopy and particle size analysis suggested that BD produced by ED and RD had no difference in size. CONCLUSION Tendon-bone healing was facilitated by the synergistic effect of RD and BD in femurs. CLINICAL RELEVANCE This study provides a more accessible and effective surgical strategy to promote tendon-bone healing after ACLR by increasing peritunnel bone and preventing BTE in femurs.
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Affiliation(s)
- Weinan Yang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Congsun Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Xiaoxiao Ji
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Minjun Yao
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Jianqiao Hong
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Zihao Qu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - An Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
| | - Haobo Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedics Research Institute of Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou, China
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Teng Y, Zhang X, Da L, Hu J, Wang H, Han H, Wu M, Zhang S, Xia Y. Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction? A biomechanical study in vitro. BMC Musculoskelet Disord 2021; 22:571. [PMID: 34158018 PMCID: PMC8218482 DOI: 10.1186/s12891-021-04457-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.
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Affiliation(s)
- Yuanjun Teng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Xiaohui Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Lijun Da
- Department of Oncology, Lanzhou University Second Hospital, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Jie Hu
- The Second Clinical Medical College, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Hong Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Hua Han
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Meng Wu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Shifeng Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China. .,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China.
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Kruppa P, Flies A, Wulsten D, Collette R, Duda GN, Schaser KD, Becker R, Kopf S. Significant Loss of ACL Graft Force With Tibial-Sided Soft Tissue Interference Screw Fixation Over 24 Hours: A Biomechanical Study. Orthop J Sports Med 2020; 8:2325967120916437. [PMID: 32440520 PMCID: PMC7225828 DOI: 10.1177/2325967120916437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Tibial-sided graft fixation is thought to be critical for the success of anterior cruciate ligament (ACL) reconstruction. Nevertheless, little is known about the graft force after fixation during the first 24 hours after surgery or the influence of screw diameter and length during this time. Purpose To investigate the force, over the course of 24 hours, in soft tissue grafts secured with a tibial interference screw and to evaluate the effect of different screw diameters (7, 8, and 9 mm) and lengths (25 and 30 mm) on the force in these grafts. Study Design Controlled laboratory study. Methods Quadruple-strand flexor tendon grafts were fixed with bioabsorbable interference screws in 60 porcine tibiae. Grafts were pretensioned at 80 N over 10 minutes, and screws were inserted outside-in while a preload force of 80 N was applied. Different screw lengths (25 and 30 mm) and diameters (7, 8, and 9 mm), resulting in 6 groups with 10 specimens each, were tested. After release of the preload, graft force was recorded over 24 hours. Results A significant decrease in graft force progressed in all groups over the 24-hour period. In total, a median loss of 75 N (IQR, 68-79 N) compared with the initial loading force was observed. Compared with the loading force of 80 N, this corresponded to a median loss of 91%. No significant differences in the remaining graft force could be found among the 6 different screw length and diameter groups after 10 minutes, 100 minutes, or 24 hours. Conclusion Graft force in soft tissue grafts secured with a tibial interference screw decreased substantially over the first 24 hours after fixation. Neither the screw diameter nor the screw length affected the decrease in graft force. This raises substantial questions regarding the remaining fixation strength in vivo. Clinical Relevance It should not be expected that ACL reconstruction can mechanically restabilize an injured knee as would an intact ACL. Reconstructed knees should be protected from mechanical overload in the early postoperative period.
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Affiliation(s)
- Philipp Kruppa
- Department of Plastic, Aesthetic and Reconstructive Microsurgery/Hand Surgery, Hospital Ernst von Bergmann, Potsdam, Germany.,Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany
| | - Anne Flies
- Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany
| | - Dag Wulsten
- Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany
| | - Robert Collette
- Department of Anesthesiology and Intensive Care, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Georg N Duda
- Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany
| | - Klaus-Dieter Schaser
- Department of Orthopedic and Trauma Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
| | - Sebastian Kopf
- Julius-Wolff-Institute, Charité-University Medicine Berlin, Berlin, Germany.,Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg an der Havel, Brandenburg an der Havel, Germany
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Crum R, Darren de SA, Ayeni OR, Musahl V. No Difference between Extraction Drilling and Serial Dilation for Tibial Tunnel Preparation in Anterior Cruciate Ligament Reconstruction: A Systematic Review. J ISAKOS 2018; 3. [PMID: 30505468 DOI: 10.1136/jisakos-2017-000191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Importance This review highlights a lack of consensus and need for further study regarding optimal tibial tunnel preparation method in anterior cruciate ligament reconstruction (ACLR). Objective This review examines existing clinical and biomechanical outcomes of both extraction drilling (ED) and serial dilation (SD) as a technique for tibial tunnel preparation in ACLR. Evidence Review In accordance with PRISMA guidelines, three electronic databases (MEDLINE, EMBASE, and PubMed) were searched and systematically screened in duplicate from database inception to September 6, 2017 for English-language, human studies, of all levels of evidence that examined ED and/or SD for tibial tunnel preparation in ACLR. Data including patient demographics, tibial tunnel preparation techniques, biomechanical and clinical outcomes and complications were retrieved from eligible studies. Findings ED was used in 71 patients, who were mean age 29.9 years (range: 17-50), 68% male, and followed for mean 16.5 months (range: 3.8-46). SD was used in 70 patients (70 knees), who were mean age 29.3 years (range: 18-50), 69% male, and followed for mean 14.1 months (range: 3.8-46). There were no statistically significant differences (mean preoperative; mean postoperative) for either tibial preparation technique for Lysholm (50.1; 92.5), Tegner (3.5; 6.1), International Knee Documentation Committee (IKDC) (48.8; 92.7), and Lachman or laxity scores. However, ED demonstrated statistically significant increased postoperative tibial tunnel expansion (1.8 mm versus 1.4 mm) and (at 12 weeks) graft migration at the tibial fixation site (1.3 mm versus 0.8 mm). Across biomechanical studies, there were no statistically significant differences (ED; SD) with forces required to initiate graft slippage (156 N; 174 N), graft stiffness (187 N; 186.5 N), and screw torque (1.6 N/m; 1.8 N/m). ED demonstrated a lower mean load to failure for the graft construct (433 N versus 631 N; p<0.05). Conclusions and Relevance Though biomechanical data demonstrated lower mean load to failure for the graft using ED, clinical data suggest increased tibial tunnel expansion and post-operative graft migration at the tibial fixation site. Future studies with long-term follow-up data are required to ascertain the optimal technique for graft incorporation and postoperative success. Level of Evidence IV:Systematic Review of Level I-IV studies.
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Affiliation(s)
- Raphael Crum
- University of Pittsburgh School of Medicine (Pittsburgh)
| | - S A Darren de
- University of Pittsburgh Medical Center, Center for Sports Medicine (Pittsburgh)
| | - Olufemi R Ayeni
- McMaster University, Division of Orthopaedic Surgery (Hamilton)
| | - Volker Musahl
- University of Pittsburgh Medical Center, Center for Sports Medicine (Pittsburgh)
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Interference screw insertion angle has no effect on graft fixation strength for insertional Achilles tendon reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:3606-3610. [PMID: 29445875 DOI: 10.1007/s00167-018-4864-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the effect of two interference screw insertion angles on the biomechanical properties of the insertional Achilles tendon (IAT) reconstruction. METHODS Nine matched pairs of fresh-frozen human cadaveric Achilles tendon specimens were randomized to two groups with interference screw insertion angles of 60° and 120°. The IAT reconstruction was performed by fixing the graft tendon with the interference screw. Each specimen was loaded to failure. The load at failure, stiffness, and mode of failure were documented. Differences in load at failure and stiffness were analysed. RESULTS There was no statistically significant difference between the 60° and 120° groups for failure load (149.137 ± 20.836 versus 155.428 ± 28.343 N, respectively, n.s.) and stiffness (14.523 ± 2.824 N/mm versus 14.727 ± 2.192 N/mm, respectively, n.s.). The most common mode of failure was the graft pulling out of the bone tunnel when the screw broke. CONCLUSIONS Graft fixation at two different interference screw insertion angles for IAT reconstruction exhibited equivalent biomechanical performance. When performing this procedure, surgeons may choose the interference screw insertion angle based on personal preference.
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Bauer LADR, Alberti HAA, Corotti VGDP, Franco APGDO, Stieven Filho E, Cunha LAMD. Biomechanical analysis of a double fixation method for tendon graft in porcine tibia – using an interference screw plus staple. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2018; 53:564-569. [PMID: 30245995 PMCID: PMC6147759 DOI: 10.1016/j.rboe.2018.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/19/2017] [Indexed: 11/18/2022]
Abstract
Objective The aim of the study was to compare the mechanical behavior of interference screw tibial fixation vs. screw-plus-staple tibial fixation in an animal model. Methods Thirty-six pieces of swine knee specimens were selected and divided into two groups: Group 1, tibial fixation with interference screw (n = 17), and Group 2, fixation with interference screw and staple (n = 19). The models were submitted to a single cycle of tension testing. The following variables were measured: graft cross-sectional area, failure point on 10 mm (F10), yield load (Fy), and stiffness. Results The mean values of graft cross-sectional area, F10, Fy, and stiffness did not present significant differences between the groups. Conclusion The addition of a second staple-type ligament fixation device, complementing the interference screw, did not increase the mechanical safety of the system.
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Bauer LADR, Alberti HAA, Corotti VGDP, Franco APGDO, Stieven Filho E, Cunha LAMD. Análise biomecânica da dupla fixação de enxerto tendinoso em tíbia porcina – uso de parafuso de interferência e agrafe. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kim SJ, Yoon JY, Kim SM, Ha S, Kim SH, Cho I. A Comparative Study on the Postoperative Outcomes of Anterior Cruciate Ligament Reconstruction Using Patellar Bone-Tendon Autografts and Bone-Patellar Tendon-Bone Autografts. Arthroscopy 2016; 32:1072-9. [PMID: 26972628 DOI: 10.1016/j.arthro.2015.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/25/2015] [Accepted: 10/12/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and compare the clinical outcomes of anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) autograft and a patellar bone-tendon (PBT) autograft. METHODS Seventy-nine patients who underwent ACL reconstruction using either a BPTB autograft or a PBT autograft were retrospectively evaluated. The minimum follow-up period was 24 months after surgery. A graft selection was determined by the patellar tendon length as measured on preoperative magnetic resonance imaging. If the patellar tendon length was longer than or equal to 45 mm, a PBT graft attached with the EndoPearl device was used. Fifty-one patients used BPTB autografts (group B) and 28 patients used PBT autografts (group P). The Lachman test, pivot-shift test, and anterior translation tested with a KT2000 arthrometer were assessed. Functional outcomes were assessed with the use of the Lysholm score, International Knee Documentation Committee subjective score, and objective grade. Anterior knee pain including kneeling pain was assessed with the use of the Shelbourne and Trumper questionnaire. RESULTS There was no statistically significant difference between the 2 groups in the postoperative values of degree of anterior translation (P = .76), Lysholm score (P = .62), International Knee Documentation Committee subjective score (P = .91), and objective grade (P = .91). However, anterior knee pain assessed with the use of the Shelbourne and Trumper questionnaire (group B = 90 [range, 65 to 100], group P = 95 [range, 59 to 100], P = .02) and number of patients having kneeling pain (group B = 41%, group P = 18%, P = .04) differed significantly between the 2 groups. CONCLUSIONS ACL reconstruction using a PBT autograft provided reliable knee stability comparable to a BPTB autograft but with less kneeling pain. For patients who have a long patellar tendon that may cause graft-tunnel mismatch, a PBT can be an effective alternative graft option for arthroscopic ACL reconstruction. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopedic Surgery, Gangdong Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Ji-Young Yoon
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong-Min Kim
- Department of Orthopedic Surgery, Yonsei Mucheoknaeun Hospital, Seoul, Republic of Korea
| | - Seungjoo Ha
- Department of Orthopedic Surgery, Modu Hospital, Incheon, Republic of Korea
| | - Sung-Hwan Kim
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Inje Cho
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Omar M, Dratzidis A, Klintschar M, Kwisda S, Krettek C, Ettinger M. Are porcine flexor digitorum profundus tendons suitable graft substitutes for human hamstring tendons in biomechanical in vitro-studies? Arch Orthop Trauma Surg 2016; 136:681-6. [PMID: 26899033 DOI: 10.1007/s00402-016-2425-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Although a plenty of studies exist assessing the strength of ligamentous fixation techniques using porcine flexor digitorum profundus tendons as graft substitutes for human hamstring tendons, there is no biomechanical study comparing these two tendons. To interpret the results obtained with porcine flexor digitorum profundus tendons, knowledge of their biomechanical properties is essential. The purpose of this study was to compare the biomechanical properties of human hamstring tendons and porcine flexor digitorum profundus tendons. MATERIALS AND METHODS A total of six human hamstring tendons and six porcine flexor digitorum profundus tendons were analysed in this study. Quadruple-bundle human hamstring tendons and double-bundle porcine flexor digitorum profundus tendons with a diameter of 9 mm were used. Specimens were placed into a tensile loading fixation of a servohydraulic testing machine. Biomechanical analysis included pretensioning of the constructs at 50 N for 10 min following cyclic loading of 1500 cycles between 50 and 200 N at 0.5 Hz for measurement of elongation. Subsequently, ultimate failure load and failure mode analysis were performed with a ramp speed of 20 mm/min. RESULTS Human hamstring tendons showed significantly higher maximum load to failure values compared to porcine flexor digitorum profundus tendons (1597 ± 179.6 N vs. 1109 ± 101.9 N; p = 0.035). Human hamstring tendons yielded significantly lower initial elongation during preload, but not during cyclical loading. CONCLUSIONS When porcine flexor digitorum profundus tendons are used as graft substitutes for human hamstring tendons in biomechanical studies, maximum load to failure is underestimated while elongation is comparable to that of human hamstring tendons. Transferring results of biomechanical studies into clinical practice, the lower maximum load to failure of porcine flexor digitorum profundus tendons needs to be taken into consideration.
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Affiliation(s)
- Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Antonios Dratzidis
- Orthopaedic Surgery Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Michael Klintschar
- Institute of Forensic Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Sebastian Kwisda
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Max Ettinger
- Orthopaedic Surgery Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
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Wang L, Lin L, Feng Y, Fernandes TL, Asnis P, Hosseini A, Li G. Anterior cruciate ligament reconstruction and cartilage contact forces--A 3D computational simulation. Clin Biomech (Bristol, Avon) 2015; 30:1175-80. [PMID: 26320976 PMCID: PMC4674370 DOI: 10.1016/j.clinbiomech.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Clinical outcome studies showed a high incidence of knee osteoarthritis after anterior cruciate ligament reconstruction. Abnormal joint kinematics and loading conditions were assumed as risking factors. However, little is known on cartilage contact forces after the surgery. METHODS A validated computational model was used to simulate anatomic and transtibial single-bundle anterior cruciate ligament reconstructions. Two graft fixation angles (0° and 30°) were simulated for each reconstruction. Biomechanics of the knee was investigated in intact, anterior cruciate ligament deficient and reconstructed conditions when the knee was subjected to 134 N anterior load and 400 N quadriceps load at 0°, 30°, 60° and 90° of flexion. The tibial translation and rotation, graft forces, medial and lateral contact forces were calculated. FINDINGS When the graft was fixed at 0°, the anatomic reconstruction resulted in slightly larger lateral contact force at 0° compared to the intact knee while the transtibial technique led to higher contact force at both 0° and 30° under the muscle load. When graft was fixed at 30°, the anatomic reconstruction overstrained the knee at 0° with larger contact forces, while the transtibial technique resulted in slightly larger contact forces at 30°. INTERPRETATION This study suggests that neither the anatomic nor the transtibial reconstruction can consistently restore normal knee biomechanics at different flexion angles. The anatomic reconstruction may better restore anteroposterior stability and contact force with the graft fixed at 0°. The transtibial technique may better restore knee anteroposterior stability and articular contact force with the graft fixed at 30° of flexion.
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Affiliation(s)
- Lianxin Wang
- Bioengineering laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA 02114, USA,Department of Orthopedic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin province, PR China
| | - Lin Lin
- Bioengineering laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA 02114, USA,Institute of Sports Medicine, Peking University Third hospital, North Garden Road, Haidian District, Beijing, 100191, PR China
| | - Yong Feng
- Bioengineering laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA 02114, USA,Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, PR China
| | - Tiago Lazzaretti Fernandes
- Bioengineering laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA 02114, USA,Institute of Orthopedics and Traumatology, Hospital Das Clínicas, School of Medicine, University of São Paulo, 333 Dr. Ovídio Pires de Campos, 05403-010, São Paulo, Brazil
| | - Peter Asnis
- Bioengineering laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA 02114, USA
| | - Ali Hosseini
- Bioengineering laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA 02114, USA
| | - Guoan Li
- Bioengineering laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA 02114, USA,Corresponding author: Guoan Li, Bioengineering laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit street, Boston, MA 02114, USA, Telephone: 1-617-726-1346, Fax: 1-617-724-4392,
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