Biomechanical research of anterior cruciate ligament fixation by tibial interfacial screw combined with bone tunnel crossing technology_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SUN Rui , ZHUANG Leiting , DUAN Mingyi , LIU Xunqi ,  ZHANG Hangzhou

Department of Orthopedics-Sports Medicine/Joint Surgery, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110000, P.R.China;

Corresponding?author：

ZHANG Hangzhou, Email: zhanghz1000@sina.com

Keywords：

Anterior cruciate ligament; ligament reconstruction; interface screw; bone tunnel crossing technology; biomechanics

DOI：

10.7507/1002-1892.202104009

Video：

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Objective To compare the strength difference between the interfacial screw and the interfacial screw combined with bone tunnel crossing technology to fix the tibial end of ligament during anterior cruciate ligament (ACL) reconstruction through the biomechanical test.Methods Twenty fresh frozen pig tibia were randomly divided into two groups (n=10) to prepare ACL reconstruction models. The graft tendons in the experimental group were fixed with interfacial screw combined with bone tunnel crossing technology, and the graft tendons in the control group were fixed with interfacial screw. The two groups of specimens were fixed in the high-frequency dynamic mechanics test system M-3000, and the length change (displacement), ultimate load, and stiffness of graft tendons were measured through the reciprocating test and load-failure test.Results The results of reciprocating test showed that the displacement of the experimental group was (3.06±0.58) mm, and that of the control group was (2.82±0.46) mm, and there was no significant difference between the two groups (t=0.641, P=0.529). The load-failure test results showed that the stiffness of the experimental group and the control group were (95.39±13.63) and (91.38±14.28) N/mm, respectively, with no significant difference (t=1.021, P=0.321). The ultimate load of the experimental group was (743.15±173.96) N, which was significantly higher than that of the control group (574.70±74.43) N (t=2.648, P=0.016).Conclusion In ACL reconstruction, the fixation strength of tibial end with interface screw combined with bone tunnel crossing technology is obviously better than that of interface screw alone.

Citation： SUN Rui, ZHUANG Leiting, DUAN Mingyi, LIU Xunqi, ZHANG Hangzhou. Biomechanical research of anterior cruciate ligament fixation by tibial interfacial screw combined with bone tunnel crossing technology. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(10): 1298-1302. doi: 10.7507/1002-1892.202104009 Copy

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3.	Cristiani R, Janarv PM, Engstr?m B, et al. Delayed anterior cruciate ligament reconstruction increases the risk of abnormal prereconstruction laxity, cartilage, and medial meniscus injuries. Arthroscopy, 2021, 37(4): 1214-1220.
4.	Teng Y, Zhang X, Da L, et al. 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(1): 571. doi: 10.1186/s12891-021-04457-5.
5.	Daneshvarhashjin N, Chizari M, Mortazavi J, et al. Can the body slope of interference screw affect initial stability of reconstructed anterior cruciate ligament?: An in-vitro investigation. BMC Musculoskelet Disord, 2021, 22(1): 556. doi: 10.1186/s12891-021-04446-8.
6.	Fang CH, Li M, Zhang YF, et al. Extra-articular migration of PEEK interference screw after anterior cruciate ligament reconstruction: a report of two cases. BMC Musculoskelet Disord, 2021, 22(1): 498. doi: 10.1186/s12891-021-04387-2.
7.	Laumonerie P, Tibbo ME, Laumond G, et al. Does a combined screw and dowel construct improve tibial fixation during anterior cruciate ligament reconstruction? Eur J Orthop Surg Traumatol, 2021. doi: 10.1007/s00590-021-03049-2.
8.	Abeyewardene S, Geertman T, Ganss A, et al. Anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft and dual tibial fixation. Arthrosc Tech, 2021, 10(7): e1661-e1667.
9.	Lee D, Stinner D, Mir H. Quadriceps and patellar tendon ruptures. J Knee Surg, 2013, 26(5): 301-308.
10.	Massey PA, Myers M, McClary K, et al. Biomechanical analysis of patellar tendon repair with knotless suture anchor tape versus transosseous suture. Orthop J Sports Med, 2020, 8(10): 1-8.
11.	Kousa P, J?rvinen TL, Vihavainen M, et al. The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part Ⅰ: femoral site. Am J Sports Med, 2003, 31(2): 174-181.
12.	Lee JJ, Otarodifard K, Jun BJ, et al. Is supplementary fixation necessary in anterior cruciate ligament reconstructions? Am J Sports Med, 2011, 39(2): 360-365.
13.	Walsh MP, Wijdicks CA, Parker JB, et al. A comparison between a retrograde interference screw, suture button, and combined fixation on the tibial side in an all-inside anterior cruciate ligament reconstruction: a biomechanical study in a porcine model. Am J Sports Med, 2009, 37(1): 160-167.
14.	Attal R, Mayr R, Heinrichs C, et al. Biomechanical comparison of2 anterior cruciate ligament graft preparation techniques for tibial fixation: response. Am J Sports Med, 2015, 43(9): NP38-39.
15.	Choi NH, Lee JH, Son KM, et al. Tibial tunnel widening after anterior cruciate ligament reconstructions with hamstring tendons using Rigidfix femoral fixation and Intrafix tibial fixation. Knee Surg Sports Traumatol Arthrosc, 2010, 18(1): 92-97.
16.	Sun L, Zhou X, Wu B, et al. Inhibitory effect of synovial fluid on tendon-to-bone healing: an experimental study in rabbits. Arthroscopy, 2012, 28(9): 1297-1305.
17.	Itoh S, Muneta T, Shinomiya K, et al. Electron microscopic evaluation of the effects of stress-shielding on maturation of the mid-substance and ligament-bone junction of the reconstructed anterior cruciate ligament in rabbits. J Mater Sci Mater Med, 1999, 10(3): 185-190.
18.	Yamakado K, Kitaoka K, Yamada H, et al. The influence of mechanical stress on graft healing in a bone tunnel. Arthroscopy, 2002, 18(1): 82-90.

1. Evans J, Nielson JL. Anterior cruciate ligament knee injuries. Treasure Island: Stat Pearls Publishing, 2021: 1-2.
2. 鐘名金, 敖英芳. 膝關節前交叉韌帶斷裂對健側膝關節軟骨影響的實驗研究. 中國運動醫學雜志, 2020, 39(8): 635-639.
3. Cristiani R, Janarv PM, Engstr?m B, et al. Delayed anterior cruciate ligament reconstruction increases the risk of abnormal prereconstruction laxity, cartilage, and medial meniscus injuries. Arthroscopy, 2021, 37(4): 1214-1220.
4. Teng Y, Zhang X, Da L, et al. 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(1): 571. doi: 10.1186/s12891-021-04457-5.
5. Daneshvarhashjin N, Chizari M, Mortazavi J, et al. Can the body slope of interference screw affect initial stability of reconstructed anterior cruciate ligament?: An in-vitro investigation. BMC Musculoskelet Disord, 2021, 22(1): 556. doi: 10.1186/s12891-021-04446-8.
6. Fang CH, Li M, Zhang YF, et al. Extra-articular migration of PEEK interference screw after anterior cruciate ligament reconstruction: a report of two cases. BMC Musculoskelet Disord, 2021, 22(1): 498. doi: 10.1186/s12891-021-04387-2.
7. Laumonerie P, Tibbo ME, Laumond G, et al. Does a combined screw and dowel construct improve tibial fixation during anterior cruciate ligament reconstruction? Eur J Orthop Surg Traumatol, 2021. doi: 10.1007/s00590-021-03049-2.
8. Abeyewardene S, Geertman T, Ganss A, et al. Anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft and dual tibial fixation. Arthrosc Tech, 2021, 10(7): e1661-e1667.
9. Lee D, Stinner D, Mir H. Quadriceps and patellar tendon ruptures. J Knee Surg, 2013, 26(5): 301-308.
10. Massey PA, Myers M, McClary K, et al. Biomechanical analysis of patellar tendon repair with knotless suture anchor tape versus transosseous suture. Orthop J Sports Med, 2020, 8(10): 1-8.
11. Kousa P, J?rvinen TL, Vihavainen M, et al. The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part Ⅰ: femoral site. Am J Sports Med, 2003, 31(2): 174-181.
12. Lee JJ, Otarodifard K, Jun BJ, et al. Is supplementary fixation necessary in anterior cruciate ligament reconstructions? Am J Sports Med, 2011, 39(2): 360-365.
13. Walsh MP, Wijdicks CA, Parker JB, et al. A comparison between a retrograde interference screw, suture button, and combined fixation on the tibial side in an all-inside anterior cruciate ligament reconstruction: a biomechanical study in a porcine model. Am J Sports Med, 2009, 37(1): 160-167.
14. Attal R, Mayr R, Heinrichs C, et al. Biomechanical comparison of2 anterior cruciate ligament graft preparation techniques for tibial fixation: response. Am J Sports Med, 2015, 43(9): NP38-39.
15. Choi NH, Lee JH, Son KM, et al. Tibial tunnel widening after anterior cruciate ligament reconstructions with hamstring tendons using Rigidfix femoral fixation and Intrafix tibial fixation. Knee Surg Sports Traumatol Arthrosc, 2010, 18(1): 92-97.
16. Sun L, Zhou X, Wu B, et al. Inhibitory effect of synovial fluid on tendon-to-bone healing: an experimental study in rabbits. Arthroscopy, 2012, 28(9): 1297-1305.
17. Itoh S, Muneta T, Shinomiya K, et al. Electron microscopic evaluation of the effects of stress-shielding on maturation of the mid-substance and ligament-bone junction of the reconstructed anterior cruciate ligament in rabbits. J Mater Sci Mater Med, 1999, 10(3): 185-190.
18. Yamakado K, Kitaoka K, Yamada H, et al. The influence of mechanical stress on graft healing in a bone tunnel. Arthroscopy, 2002, 18(1): 82-90.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical research of anterior cruciate ligament fixation by tibial interfacial screw combined with bone tunnel crossing technology

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