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Journal of Orthopaedics and Traumatology

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Open Access 01-12-2018 | Original Article

Can tape–screw fixation of a quadrupled semitendinosus graft in a full-length tibial tunnel provide superior fixation compared with a doubled semitendinosus–gracilis held with an interference screw? A matched-pair cadaveric biomechanical comparison

Authors: Christopher J. Vertullo, Joseph Cadman, Dané Dabirrahmani, Richard Appleyard

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2018

Abstract

Background

In anterior cruciate ligament reconstruction, quadrupled semitendinosus (Quad ST) grafts have potential advantages over doubled semitendinosus–gracilis (ST/G) including larger diameter and gracilis preservation, however the ideal tibial fixation method of the resultant shorter Quad ST graft remains elusive if a fixed-loop suspensory fixation device is used on the femur. We investigated whether the tibial fixation biomechanical properties of a Quad ST fixed indirectly with polyethylene terephthalate tape tied over a screw in a full outside-in created tunnel was superior to a ST/G graft fixed with an interference screw.

Materials and methods

In a controlled laboratory study, six cadaveric matched pairs of each construct were subjected to cyclic loading to mimic physiologic loading during rehabilitation. This included preconditioning cycling, cyclic loading to 220 N for 500 cycles, then cyclic loading to 500 N for 500 cycles.

Results

High standard deviations across the measured parameters occurred with no significant difference between measured parameters of elongation for the different constructs. Elongation of the Quad-ST construct was greater at 10 and 100 cycles, but not statistically different. Four of the six Quad-ST constructs failed below 100 cycles, compared with two failures below 100 cycles in the ST/G construct. There was a strong correlation between cycles to failure and bone mineral density for the Quad ST-tape constructs.

Conclusions

Tibial fixation of Quad ST with a tied tape–screw construct in a full-length tunnel was not biomechanically superior to ST/G graft fixed with an interference screw, exhibited greater nonsignificant construct elongation with earlier failure, and was more reliant on bone mineral density.

Level of evidence

In vitro laboratory study.

Budny J, Fox J, Rauh M, Fineberg M (2016) Emerging trends in anterior cruciate ligament reconstruction. J Knee Surg. https://doi.org/10.1055/s-0036-1579788 PubMedCrossRef

Pinczewski LA, Lyman J, Salmon LJ, Russell VJ, Roe J, Linklater J (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574. https://doi.org/10.1177/0363546506296042 CrossRefPubMed

Kane PW, Wascher J, Dodson CC, Hammoud S, Cohen SB, Ciccotti MG (2016) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft in skeletally mature patients aged 25 years or younger. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. https://doi.org/10.1007/s00167-016-4213-z CrossRef

Steadman JR, Matheny LM, Hurst JM, Briggs KK (2015) Patient-centered outcomes and revision rate in patients undergoing ACL reconstruction using bone-patellar tendon-bone autograft compared with bone-patellar tendon-bone allograft: a matched case–control study. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 31:2320–2326. https://doi.org/10.1016/j.arthro.2015.06.009 CrossRef

Gifstad T, Foss OA, Engebretsen L, Lind M, Forssblad M, Albrektsen G et al (2014) Lower risk of revision with patellar tendon autografts compared with hamstring autografts: a registry study based on 45,998 primary ACL reconstructions in Scandinavia. Am J Sports Med 42:2319–2328. https://doi.org/10.1177/0363546514548164 CrossRefPubMed

Mohtadi N, Chan D, Barber R, Paolucci EO (2016) Reruptures, reinjuries, and revisions at a minimum 2-year follow-up: a randomized clinical trial comparing 3 graft types for ACL reconstruction. Clin J Sport Med Off J Can Acad Sport Med 26:96–107. https://doi.org/10.1097/JSM.0000000000000209 CrossRef

Tashiro T, Kurosawa H, Kawakami A, Hikita A, Fukui N (2003) Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction a detailed evaluation with comparison of single- and double-tendon harvest. Am J Sports Med 31:522–529CrossRefPubMed

Yosmaoglu HB, Baltaci G, Ozer H, Atay A (2011) Effects of additional gracilis tendon harvest on muscle torque, motor coordination, and knee laxity in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 19:1287–1292. https://doi.org/10.1007/s00167-011-1412-5 CrossRef

Konrath JM, Vertullo CJ, Kennedy BA, Bush HS, Barrett RS, Lloyd DG (2016) Morphologic characteristics and strength of the hamstring muscles remain altered at 2 years after use of a hamstring tendon graft in anterior cruciate ligament reconstruction. Am J Sports Med. https://doi.org/10.1177/0363546516651441 PubMedCrossRef

10.

Sharma A, Flanigan DC, Randall K, Magnussen RA (2016) Does gracilis preservation matter in anterior cruciate ligament reconstruction? A systematic review. Arthrosc J Arthrosc Relat Surg. https://doi.org/10.1016/j.arthro.2015.11.027 CrossRef

11.

Magnussen RA, Lawrence JTR, West RL, Toth AP, Taylor DC, Garrett WE (2012) Graft size and patient age are predictors of early revision after anterior cruciate ligament reconstruction with hamstring autograft. Arthrosc J Arthrosc Relat Surg 28:526–531CrossRef

12.

Mariscalco MW, Flanigan DC, Mitchell J, Pedroza AD, Jones MH, Andrish JT et al (2013) The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a multicenter orthopaedic outcomes network (MOON) cohort study. Arthrosc J Arthrosc Relat Surg 29:1948–1953. https://doi.org/10.1016/j.arthro.2013.08.025 CrossRef

13.

Karimi-Mobarakeh M, Mardani-Kivi M, Mortazavi A, Saheb-Ekhtiari K, Hashemi-Motlagh K (2015) Role of gracilis harvesting in four-strand hamstring tendon anterior cruciate ligament reconstruction: a double-blinded prospective randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 23:1086–1091. https://doi.org/10.1007/s00167-014-2890-z CrossRefPubMed

14.

Collette M (2012) An innovative method of hamstring graft preparation and a new concept of intratunnel tendon fixation: biomechanical evaluation. Curr Orthop Pract 23:577–583CrossRef

15.

Barrow AE, Pilia M, Guda T, Kadrmas WR, Burns TC (2014) Femoral suspension devices for anterior cruciate ligament reconstruction: do adjustable loops lengthen? Am J Sports Med 42:343–349. https://doi.org/10.1177/0363546513507769 CrossRefPubMed

16.

Mayr R, Heinrichs CH, Eichinger M, Coppola C, Schmoelz W, Attal R (2015) Biomechanical comparison of 2 anterior cruciate ligament graft preparation techniques for tibial fixation: adjustable-length loop cortical button or interference screw. Am J Sports Med 43:1380–1385. https://doi.org/10.1177/0363546515574062 CrossRefPubMed

17.

Barrow AE, Burns TC (2016) Regarding “biomechanical and computed tomography analysis of adjustable femoral cortical fixation devices for anterior cruciate ligament reconstruction in a cadaveric human knee model”. Arthrosc J Arthrosc Relat Surg 32:1225–1226. https://doi.org/10.1016/j.arthro.2016.04.006 CrossRef

18.

Smith PA, DeBerardino TM (2015) Biomechanical comparison of 2 anterior cruciate ligament graft preparation techniques for tibial fixation: letter to the editor. Am J Sports Med 43:NP37. https://doi.org/10.1177/0363546515601385 CrossRefPubMed

19.

Smith PA, DeBerardino TM (2015) Tibial fixation properties of a continuous-loop ACL hamstring graft construct with suspensory fixation in porcine bone. J Knee Surg 28:506–512. https://doi.org/10.1055/s-0034-1394167 PubMedCrossRef

20.

Caborn DNM, Brand JC, Nyland J, Kocabey Y (2004) A biomechanical comparison of initial soft tissue tibial fixation devices: the intrafix versus a tapered 35-mm bioabsorbable interference screw. Am J Sports Med 32:956–961CrossRefPubMed

21.

Kousa P, Järvinen TLN, Vihavainen M, Kannus P, Järvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part II: tibial site. Am J Sports Med 31:182–188CrossRefPubMed

22.

Calas P, Dorval N, Bloch A, Argenson J-N, Parratte S (2012) A new anterior cruciate ligament reconstruction fixation technique (quadrupled semitendinosus anterior cruciate ligament reconstruction with polyetheretherketone cage fixation). Arthrosc Tech 1:e47–e52. https://doi.org/10.1016/j.eats.2012.01.001 CrossRefPubMedPubMedCentral

23.

Birmingham P, Hein J, McGrady LM, Bowers MW, Wang M (2014) ACL reconstruction using a short hamstring graft and tape locking screw: a biomechanical study. Orthop. Res. Soc, New Orleans

24.

Weiler A, Hoffmann RFG, Bail HJ, Rehm O, Südkamp NP (2002) Tendon healing in a bone tunnel. Part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 18:124–135CrossRef

25.

BIOSURE HA and BIOSURE PK Interference Screws|Smith and Nephew—US Professional n.d. http://www.smith-nephew.com/professional/products/all-products/biosure-ha-and-biosure-pk-interference-screws/. Accessed 15 Dec 2015

26.

Tera H, Aberg C (1977) Strength of knots in surgery in relation to type of knot, type of suture material and dimension of suture thread. Acta Chir Scand 143:75–83PubMed

27.

Coleridge S, Amis A (2004) A comparison of five tibial-fixation systems in hamstring-graft anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 12:391–397. https://doi.org/10.1007/s00167-003-0488-y CrossRefPubMed

28.

Ehrensberger M, Hohman DW, Duncan K, Howard C, Bisson L (2013) Biomechanical comparison of femoral fixation devices for anterior cruciate ligament reconstruction using a novel testing method. Clin Biomech Bristol Avon 28:193–198. https://doi.org/10.1016/j.clinbiomech.2012.12.007 CrossRef

29.

Robert H, Bowen M, Odry G, Collette M, Cassard X, Lanternier H et al (2015) A comparison of four tibial-fixation systems in hamstring-graft anterior ligament reconstruction. Eur J Orthop Surg Traumatol 25:339–347. https://doi.org/10.1007/s00590-014-1473-5 CrossRefPubMed

30.

Harrell RM, Tong J, Weinhold PS, Dahners LE (2003) Comparison of the mechanical properties of different tension band materials and suture techniques. J Orthop Trauma 17:119–122CrossRefPubMed

31.

Magen HE, Howell SM, Hull ML (1999) Structural properties of six tibial fixation methods for anterior cruciate ligament soft tissue grafts. Am J Sports Med 27:35–43CrossRefPubMed

Title: Can tape–screw fixation of a quadrupled semitendinosus graft in a full-length tibial tunnel provide superior fixation compared with a doubled semitendinosus–gracilis held with an interference screw? A matched-pair cadaveric biomechanical comparison
Authors: Christopher J. Vertullo
Joseph Cadman
Dané Dabirrahmani
Richard Appleyard
Publication date: 01-12-2018
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 1/2018
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1186/s10195-018-0495-x

At a glance: The STEP trials

Springer Medicine

Can tape–screw fixation of a quadrupled semitendinosus graft in a full-length tibial tunnel provide superior fixation compared with a doubled semitendinosus–gracilis held with an interference screw? A matched-pair cadaveric biomechanical comparison

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of evidence

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