Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

28-04-2023 | KNEE

Smaller diameter femoral tunnel biocomposite interference screws provide adequate fixation strength in anterior cruciate ligament reconstruction

Authors: Jason G. Ina, Mark F. Megerian, Derrick M. Knapik, Jacob G. Calcei, Clare M. Rimnac, James E. Voos

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2023

Abstract

Purpose

The purpose of this study was to evaluate the effect of bioabsorbable interference screw diameter on the pullout strength and failure mode for femoral tunnel fixation in primary anterior cruciate ligament reconstruction (ACLR) at time zero fixation using bone-patellar tendon-bone (BTB) autograft in a cadaveric model.

Methods

Twenty-four fresh-frozen cadaveric knees were obtained from 17 different donors. Specimens were allocated to three different treatment groups (n = 8 per group) based on interference screw diameter: 6 mm, 7 mm, or 8 mm biocomposite interference screw. All specimens underwent dual energy X-ray absorptiometry (DEXA) scanning prior to allocation to ensure no difference in bone mineral density among groups (n.s.). All specimens underwent femoral-sided ACLR with BTB autograft. Specimens subsequently underwent mechanical testing under monotonic loading conditions to failure. The load to failure and failure mechanism were recorded.

Results

The mean pullout force (N) at time zero for each group was 309 ± 213 N, 518 ± 313 N, and 541 ± 267 N for 6 mm, 7 mm, and 8 mm biocomposite interference screw diameter, respectively (n.s.). One specimen in the 6 mm group, two specimens in the 7 mm group, and one specimen in the 8 mm group failed by screw pullout. The remainder in each group failed by graft failure (n.s.).

Conclusion

Biocomposite interference screw diameter did not have a significant influence on fixation pullout strength or failure mode following femoral tunnel fixation using BTB autograft at time zero. A 6 mm interference screw can improve preservation of native bone stock, increase potential for biologic healing, and decrease the risk of damage to the graft during insertion without significantly compromising fixation strength. This study supports the use of smaller 6 mm interference screw diameter options for femoral tunnel fixation in ACLR.

Available only for authorised users

Su CA, Knapik DM, Trivedi NN, Megerian MF, Salata MJ, Voos JE (2020) Femoral interference screw fixation in ACL reconstruction using bone-patellar tendon-bone grafts. JBJS Rev 8(1):e0066CrossRefPubMed

Dai W, Leng X, Wang J, Cheng J, Hu X, Ao Y (2022) Quadriceps tendon autograft versus bone-patellar tendon–bone and hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 50(12):3425–3439CrossRefPubMed

Salmon LJ, Russell VJ, Refshauge K, Kader D, Connolly C, Linklater J, Pinczewski LA (2006) Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 34(5):721–732CrossRefPubMed

Samuelsen BT, Webster KE, Johnson NR, Hewett TE, Krych AJ (2017) Hamstring autograft versus patellar tendon autograft for ACL reconstruction: is there a difference in graft failure rate? A meta-analysis of 47,613 patients. Clin Orthop Relat Res 475(10):2459–2468CrossRefPubMedPubMedCentral

Kruse LM, Gray B, Wright RW (2012) Rehabilitation after anterior cruciate ligament reconstruction. J Bone Joint Surg Am 94(19):1737–1748CrossRefPubMedPubMedCentral

Piedade SR, Leite Arruda BP, Antunes de Vasconcelos R, Parker DA, Maffulli N (2022) Rehabilitation and advances in surgical reconstruction for anterior cruciate ligament insufficiency: what has changed since the 1960s? State of the art. J ISAKOS S2059–7754(22):00094–00103

Carmichael JR, Cross MJ (2009) Why bone–patella tendon–bone grafts should still be considered the gold standard for anterior cruciate ligament reconstruction. Br J Sports Med 43(5):323–325CrossRefPubMed

Hurley ET, Calvo-Gurry M, Withers D, Farrington SK, Moran R, Moran CJ (2018) Quadriceps tendon autograft in anterior cruciate ligament reconstruction: a systematic review. Arthroscopy 34(5):1690–1698CrossRefPubMed

MOON Knee Group, Spindler KP, Huston LJ, Zajichek A, Reinke EK, Amendola A, Andrish JT, Brophy RH, Dunn WR, Flanigan DC, Jones MH, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Vidal AF, Wolcott ML, Wolf BR, Wright RW (2020) Anterior cruciate ligament reconstruction in high school and college-aged athletes: does autograft choice influence anterior cruciate ligament revision rates? Am J Sports Med 48(2):298–309CrossRef

10.

Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS (1984) Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 66(3):344–352CrossRefPubMed

11.

Salem HS, Varzhapetyan V, Patel N, Dodson CC, Tjoumakaris FP, Freedman KB (2019) Anterior cruciate ligament reconstruction in young female athletes: patellar versus hamstring tendon autografts. Am J Sports Med 47(9):2086–2092CrossRefPubMed

12.

Lubowitz JH, Schwartzberg R, Smith P (2015) Cortical suspensory button versus aperture interference screw fixation for knee anterior cruciate ligament soft-tissue allograft: a prospective. Randomized Controlled Trial Arthroscopy 31(9):1733–1739PubMed

13.

Saccomanno MF, Shin JJ, Mascarenhas R, Haro M, Verma NN, Cole BJ, Bach BR (2014) Clinical and functional outcomes after anterior cruciate ligament reconstruction using cortical button fixation versus transfemoral suspensory fixation: a systematic review of randomized controlled trials. Arthrscopy 30(11):1491–1498CrossRef

14.

Vaidya R, Roth M, Nanavati D, Prince M, Sethi A (2015) Low-velocity knee dislocations in obese and morbidly obese patients. Orthop J Sports Med 3(4):2325967115575719CrossRefPubMedPubMedCentral

15.

Frosch S, Rittstieg A, Balcarek P, Walde TA, Schüttrumpf JP, Wachowski MM, Stürmer KM, Frosch K-H (2012) Bioabsorbable interference screw versus bioabsorbable cross pins: influence of femoral graft fixation on the clinical outcome after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 20(11):2251–2256CrossRefPubMedPubMedCentral

16.

Lambert KL (1983) Vascularized patellar tendon graft with rigid internal fixation for anterior cruciate ligament insufficiency. Clin Orthop Relat Res 172:85–89CrossRef

17.

Brown CH, Hecker AT, Hipp JA, Myers ER, Hayes WC (1993) The biomechanics of interference screw fixation of patellar tendon anterior cruciate ligament grafts. Am J Sports Med 21(6):880–886CrossRefPubMed

18.

Butler JC, Branch TP, Hutton WC (1994) Optimal graft fixation—the effect of gap size and screw size on bone plug fixation in ACL reconstruction. Arthroscopy 10(5):524–529CrossRefPubMed

19.

Eichinger M, Schmoelz W, Attal R, Moroder A, Heinrichs CH, Smekal V, Mayr R (2018) Screw oversizing for anterior cruciate ligament graft fixation in primary and enlarged tibial tunnels: a biomechanical study in a porcine model. Knee 25(5):774–781CrossRefPubMed

20.

Ezechieli M, Ettinger M, König C, Weizbauer A, Helmecke P, Schavan R, Lucas A, Windhagen H, Becher C (2016) Biomechanical characteristics of bioabsorbable magnesium-based (MgYREZr-alloy) interference screws with different threads. Knee Surg Sports Traumatol Arthrosc 24(12):3976–3981CrossRefPubMed

21.

Shapiro JD, Jackson DW, Aberman HM, Lee TQ, Simon TM (1995) Comparison of pullout strength for seven- and nine-millimeter diameter interference screw size as used in anterior cruciate ligament reconstruction. Arthroscopy 11(5):596–599CrossRefPubMed

22.

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

23.

Micucci CJ, Frank DA, Kompel J, Muffly M, DeMeo PJ, Altman GT (2010) The effect of interference screw diameter on fixation of soft-tissue grafts in anterior cruciate ligament reconstruction. Arthroscopy 26(8):1105–1110CrossRefPubMed

24.

Kohn D, Rose C (1994) Primary stability of interference screw fixation: influence of screw diameter and insertion torque. Am J Sports Med 22(3):334–338CrossRefPubMed

25.

Brown GA, Peña F, Grøntvedt T, Labadie D, Engebretsen L (1996) Fixation strength of interference screw fixation in bovine, young human, and elderly human cadaver knees: influence of insertion torque, tunnel-bone block gap, and interference. Knee Surg Sports Traumatol Arthrosc 3(4):238–244CrossRefPubMed

26.

Mitchell JJ, Dean CS, Chahla J, Menge TJ, Cram TR, LaPrade RF (2016) Posterior wall blowout in anterior cruciate ligament reconstruction. Orthop J Sports Med 4(6):2325967116652122CrossRefPubMedPubMedCentral

27.

Palazzolo A, Rosso F, Bonasia DE, Saccia F, Rossi R (2018) Uncommon complications after anterior cruciate ligament reconstruction. Joints 6(3):188–203CrossRefPubMedPubMedCentral

28.

Rue J-PH, Busam ML, Detterline AJ, Bach BR (2008) Posterior wall blowout in anterior cruciate ligament reconstruction: avoidance, recognition, and salvage. J Knee Surg 21(3):235–240CrossRefPubMed

29.

Markolf K, Gorek J, Kabo M, Shapiro M (1990) Direct measurement of resultant forces in the anterior cruciate ligament. An in vitro study performed with a new experimental technique. J Bone Joint Surg Am 72(4):557–567CrossRefPubMed

30.

Domnick C, Raschke MJ, Herbort M (2016) Biomechanics of the anterior cruciate ligament: physiology, rupture and reconstruction techniques. World J Orthop 7(2):82–93CrossRefPubMedPubMedCentral

31.

Freudmann M, Bollen S (2011) The demographics of ACL injury over a twelve year period: is skiing to blame for the changes? Orthop Proc 93-B:13–13

32.

Liukkonen RJ, Ponkilainen VT, Reito A (2022) Revision rates after primary ACL reconstruction performed between 1969 and 2018: a systematic review and metaregression analysis. Orthop J Sports Med 10(8):23259671221110190CrossRefPubMedPubMedCentral

33.

Moretti L, Bizzoca D, Cassano GD, Caringella N, Delmedico M, Moretti B (2022) Graft intra-articular remodeling and bone incorporation in ACL reconstruction: the state of the art and clinical implications. J Clin Med 11(22):6704. https://doi.org/10.3390/jcm11226704CrossRefPubMedPubMedCentral

34.

Arama Y, Salmon LJ, Sri-Ram K, Linklater J, Roe JP, Pinczewski LA (2015) Bioabsorbable versus titanium screws in anterior cruciate ligament reconstruction using hamstring autograft: a prospective, blinded, randomized controlled trial with 5-year follow-up. Am J Sports Med 43(8):1893–1901CrossRefPubMed

35.

Barber FA, Dockery WD (2020) Biocomposite interference screws in anterior cruciate ligament reconstruction: osteoconductivity and degradation. Arthroscopy 2:e53

Title: Smaller diameter femoral tunnel biocomposite interference screws provide adequate fixation strength in anterior cruciate ligament reconstruction
Authors: Jason G. Ina
Mark F. Megerian
Derrick M. Knapik
Jacob G. Calcei
Clare M. Rimnac
James E. Voos
Publication date: 28-04-2023
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07421-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Smaller diameter femoral tunnel biocomposite interference screws provide adequate fixation strength in anterior cruciate ligament reconstruction

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2023

Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: a prospective multicentric study

Osteotomy around the painful degenerative varus knee: a 2022 ESSKA formal consensus

No difference in patient reported outcomes, laxity, and failure rate after revision ACL reconstruction with quadriceps tendon compared to hamstring tendon graft: a systematic review and meta-analysis

Survival of anterior cruciate ligament reconstructions in active-duty military populations

Non-operative management for osteochondral lesions of the talus: a systematic review of treatment modalities, clinical- and radiological outcomes

Quadriceps and hamstring anterior cruciate ligament reconstruction differ only marginally in function after the rehabilitation: a propensity score-matched case–control study