Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 25, Issue 7 , Pages 767-776 , July 2009

Suspensory Fixation of Grafts in Anterior Cruciate Ligament Reconstruction: A Biomechanical Comparison of 3 Implants

  • Florian S. Kamelger, M.D.

      Affiliations

    • Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria
    • Corresponding Author InformationAddress correspondence and reprint requests to Florian S. Kamelger, M.D., Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
    • ,
  • Ursula Onder, M.D.

      Affiliations

    • Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria
    • ,
  • Werner Schmoelz, Dr. Dipl.Ing., Ph.D.

      Affiliations

    • Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria
    • ,
  • Katja Tecklenburg, M.D.

      Affiliations

    • Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria
    • ,
  • Rohit Arora, M.D.

      Affiliations

    • Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria
    • ,
  • Christian Fink, M.D.

      Affiliations

    • Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria
    • Sportsclinic Austria, Innsbruck, Austria

Received 12 September 2008 ,Accepted 21 January 2009.

References 

  1. Beynnon BD, Johnson RJ, Abate JA, Fleming BC, Nichols CE. Treatment of anterior cruciate ligament injuries, part 2. Am J Sports Med. 2005;33:1751–1767
  2. Höher J, Möller HD, Fu FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction: Fact or fiction?. Knee Surg Sports Traumatol Arthrosc. 1998;6:231–240
  3. Barber FA, Spruill B, Sheluga M. The effect of outlet fixation on tunnel widening. Arthroscopy. 2003;19:485–492
  4. Rodeo SA, Kawamura S, Kim HJ, Dynybil C, Ying L. Tendon healing in a bone tunnel differs at the tunnel entrance versus the tunnel exit: An effect of graft-tunnel motion?. Am J Sports Med. 2006;34:1790–1800
  5. Höher J, Livesay GA, Ma CB, Withrow JD, Fu FH, Woo SL. Hamstring graft motion in the femoral bone tunnel when using titanium button/polyester tape fixation. Knee Surg Sports Traumatol Arthrosc. 1999;7:215–219
  6. Oh YH, Namkoong S, Strauss EJ, et al. Hybrid femoral fixation of soft-tissue grafts in anterior cruciate ligament reconstruction using the EndoButton CL and bioabsorbable interference screws: A biomechanical study. Arthroscopy. 2006;22:1218–1224
  7. Espejo-Baena A, Ezquerro F, de la Blanca AP, Serrano-Fernandez J, Nadal F, Montañez-Heredia E. Comparison of initial mechanical properties of 4 hamstring graft femoral fixation systems using nonpermanent hardware for anterior cruciate ligament reconstruction: An in vitro animal study. Arthroscopy. 2006;22:433–440
  8. Numazaki H, Tohyama H, Nakano H, Kikuchi S, Yasuda K. The effect of initial graft tension in anterior cruciate ligament reconstruction on the mechanical behaviors of the femur-graft-tibia complex during cyclic loading. Am J Sports Med. 2002;30:800–805
  9. Beynnon BD, Amis AA. In vitro testing protocols for the cruciate ligaments and ligament reconstructions. Knee Surg Sports Traumatol Arthrosc. 1998;6:70–76
  10. Brown CH, Wilson DR, Hecker AT, Ferragamo M. Graft-bone motion and tensile properties of hamstring and patellar tendon anterior cruciate ligament femoral graft fixation under cyclic loading. Arthroscopy. 2004;20:922–935
  11. Kousa P, Järvinen T, Vihavainen M, Kannus P, Järvinen M. The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction (Part I: Femoral site). Am J Sports Med. 2003;31:174–181
  12. Ahmad CS, Gardner TR, Groh M, Arnouk J, Levine WN. Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32:635–640
  13. Zantop T, Ruemmler M, Welbes B, Langer M, Weimann A, Petersen W. Cyclic loading comparison between biodegradable interference screw fixation and biodegradable double cross-pin fixation of human bone-patellar tendon-bone grafts. Arthroscopy. 2005;21:934–941
  14. Brand J, Weiler A, Caborn DNM, Brown C, Johnson D. Graft fixation in cruciate ligament reconstruction. Am J Sports Med. 2000;28:761–773
  15. Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am. 1984;66:344–352
  16. L'Insalata JC, Klatt B, Fu FH, Harner CD. Tunnel expansion following anterior cruciate ligament reconstruction: A comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc. 1997;5:234–238
  17. Nebelung W, Becker R, Merkel M, Ropke M. Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using EndoButton fixation on the femoral side. Arthroscopy. 1998;14:810–815
  18. Baumfeld JA, Diduch DR, Rubino LJ, et al. Tunnel widening following anterior cruciate ligament reconstruction using hamstring autograft: A comparison between double cross-pin and suspensory graft fixation. Knee Surg Sports Traumatol Arthrosc. 2008;16:1108–1113
  19. Buelow JU, Siebold R, Ellermann A. A prospective evaluation of tunnel enlargement in anterior cruciate ligament reconstruction with hamstrings: Extracortical versus anatomical fixation. Knee Surg Sports Traumatol Arthrosc. 2002;10:80–85
  20. Magen HE, Howell SM, Hull ML. Structural properties of six tibial fixation methods for anterior cruciate ligament soft tissue grafts. Am J Sports Med. 1999;27:23–43
  21. Milano G, Mulas PD, Ziranu F, Piras S, Manunta A, Fabbriciani C. Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft (A biomechanical analysis). Arthroscopy. 2006;22:660–668

 The authors report no conflict of interest.

PII: S0749-8063(09)00075-9

doi: 10.1016/j.arthro.2009.01.021

Arthroscopy: The Journal of Arthroscopic and Related Surgery
Volume 25, Issue 7 , Pages 767-776 , July 2009

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