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01-12-2014 | Original Paper

The biomechanics of biodegradable versus titanium interference screw fixation for anterior cruciate ligament augmentation and reconstruction

Authors: Max Ettinger, Diana Schumacher, Tilman Calliess, Antonios Dratzidis, Marco Ezechieli, Christof Hurschler, Christoph Becher

Published in: International Orthopaedics | Issue 12/2014

Abstract

Purpose

The ligament augmentation and reconstruction system (LARS) is one of the options available for anterior cruciate ligament (ACL) reconstruction. To date, however, there are no published data regarding the biomechanical properties of LARS fixation for ACL reconstruction. The aim of this study was to investigate the biomechanical properties of various LARS interference-screw fixations.

Methods

A total of 100 LARS ligaments were fixed in porcine femurs with five different interference screws (four biodegradable screws and one titanium interference screw) introduced from inside-out or extra-articularly outside-in. Each group consisted of ten specimens. The constructs were cyclically stretched and subsequently loaded until failure. We evaluated the maximum load before failure, elongation during cyclic loading, stiffness, and failure mode.

Results

Elongation during cyclical loading for all devices tested was significantly larger between the first and 20th cycles than between the 20th and 500th cycles (p < 0.05). Maximum failure load was not significantly lower for the biodegradable screws than for the titanium screws (p > 0.05). All specimens failed because of ligament pull-out from the bony tunnel.

Conclusions

Our findings suggest that biomechanical secure fixation of the LARS for ACL reconstruction can be achieved using either biodegradable or titanium interference screws. The stability of fixation is independent of the approach, type of investigation, and type of fixation (extra-articular outside-in or intra-articular inside-out).

Brand J, Weiler A, Caborn DNM, Brown CH, Johnson DL (2000) Graft fixation in cruciate ligament reconstruction. Am J Sports Med 28(5):761–764PubMed

Brand JC, Nyland J, Caborn DNM, Johnson DL (2005) Soft-tissue interference fixation: bioabsorbable screw versus metal screw. Arthroscopy 21(8):911–916PubMedCrossRef

Brown CH, Wilson DR, Hecker AT, Ferragamo M (2004) Graft-bone motion and tensile properties of hamstring and patellar tendon anterior cruciate ligament femoral graft fixation under cyclic loading. Arthroscopy 20(9):922–935PubMedCrossRef

Ettinger M, Petri M, Haag KT, Brand S, Dratzidis A, Hurschler C, Krettek C, Jagodzinski M (2013) Biomechanical properties of femoral posterior cruciate ligament fixations. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2600-2

Ettinger M, Wehrhahn T, Petri M, Liodakis E, Olender G, Albrecht UV, Hurschler C, Krettek C, Jagodzinski M (2012) The fixation strength of tibial PCL press-fit reconstructions. Knee Surg Sports Traumatol Arthrosc 20(2):308–314PubMedCrossRef

Frank CB, Jackson DW (1997) The science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 79(10):1556–1576PubMed

Hamido F, Misfer AK, Al Harran H, Khadrawe TA, Soliman A, Talaat A, Awad A, Khairat S (2011) The use of the LARS artificial ligament to augment a short or undersized ACL hamstrings tendon graft. Knee 18(6):373–378PubMedCrossRef

Höher J, Möller HD, Fu FH (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6(4):231–240PubMedCrossRef

Jagodzinski M, Ettinger M, Haasper C, Hankemeier S, Breitmeier D, Hurschler C, Krettek C (2010) Biomechanical analysis of press-fit fixation of anterior cruciate ligament transplants. Unfallchirurg 113(7):532–539PubMedCrossRef

10.

Kousa P, Jarvinen TLN, Vihavainen M, Kannus P, Jarvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction: part I: Femoral site. Am J Sports Med 31(2):174–181PubMed

11.

Morrison J (1970) The mechanics of the knee joint in relation to normal walking. J Biomech 3(1):51–61PubMedCrossRef

12.

Nagarkatti DG, McKeon BP, Donahue BS, Fulkerson JP (2001) Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation. Am J Sports Med 29(1):67–71PubMed

13.

Nau T, Lavoie P, Duval N (2002) A new generation of artificial ligaments in reconstruction of the anterior cruciate ligament. Two-year follow-up of a randomised trial. J Bone Joint Surg (Br) 84(3):356–360CrossRef

14.

Newman SD, Atkinson HD, Willis-Owen CA (2013) Anterior cruciate ligament reconstruction with the ligament augmentation and reconstruction system: a systematic review. Int Orthop 37(2):321–326PubMedCentralPubMedCrossRef

15.

Noyes FR, Barber-Westin SD (2001) Revision anterior cruciate surgery with use of bone-patellar tendon-bone autogenous grafts. J Bone Joint Surg Am 83-A(8):1131–1143PubMed

16.

Nurmi JT, Jarvinen TL, Kannus P, Sievanen H, Toukosalo J, Jarvinen M (2002) Compaction versus extraction drilling for fixation of the hamstring tendon graft in anterior cruciate ligament reconstruction. Am J Sports Med 30(2):167–173PubMed

17.

Weiler A, Hoffmann RF, Siepe CJ, Kolbeck SF, Suedkamp NP (2000) The influence of screw geometry on hamstring tendon interference fit fixation. Am J Sports Med 28(3):356–359PubMed

18.

Weiler A, Windhagen HJ, Raschke MJ, Laumeyer A, Hoffmann RF (1998) Biodegradable interference screw fixation exhibits pull-out force and stiffness similar to titanium screws. Am J Sports Med 26(1):119–126PubMed

19.

Yamamoto H, Ishibashi T, Muneta T, Furuya K, Mizuta T (1992) Effusions after anterior cruciate ligament reconstruction using the ligament augmentation device. Arthroscopy 8(3):305–310PubMedCrossRef

20.

Yasuda K, Tsujino J, Tanabe Y, Kaneda K (1997) Effects of initial graft tension on clinical outcome after anterior cruciate ligament reconstruction. Am J Sports Med 25(1):99–106PubMedCrossRef

21.

Zantop T, Weimann A, Schmidtko R, Herbort M, Raschke MJ, Petersen W (2006) Graft laceration and pullout strength of soft-tissue anterior cruciate ligament reconstruction: in vitro study comparing titanium, poly-d, l-lactide, and poly-d, l-lactide-tricalcium phosphate screws. Arthroscopy 22(11):1204–1210PubMedCrossRef

Title: The biomechanics of biodegradable versus titanium interference screw fixation for anterior cruciate ligament augmentation and reconstruction
Authors: Max Ettinger
Diana Schumacher
Tilman Calliess
Antonios Dratzidis
Marco Ezechieli
Christof Hurschler
Christoph Becher
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 12/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-014-2483-y

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Springer Medicine

The biomechanics of biodegradable versus titanium interference screw fixation for anterior cruciate ligament augmentation and reconstruction

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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