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Influence of Thread Design on Bioabsorbable Interference Screw Insertion Torque During Retrograde Fixation of a Soft-Tissue Graft in Synthetic Bone

  • Tanya D. Wozniak
    Affiliations
    Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A

    Frazier Rehabilitation Institute, Louisville, Kentucky, U.S.A
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  • Yavuz Kocabey
    Affiliations
    Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A

    Frazier Rehabilitation Institute, Louisville, Kentucky, U.S.A
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  • Scott Klein
    Affiliations
    Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A

    Frazier Rehabilitation Institute, Louisville, Kentucky, U.S.A
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  • John Nyland
    Correspondence
    Address correspondence and reprint requests to John Nyland, Ed.D., P.T. S.C.S., A.T.C., Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 210 East Gray St, Suite 1003, Louisville, KY 40202, U.S.A
    Affiliations
    Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A

    Frazier Rehabilitation Institute, Louisville, Kentucky, U.S.A
    Search for articles by this author
  • David N.M. Caborn
    Affiliations
    Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A

    Frazier Rehabilitation Institute, Louisville, Kentucky, U.S.A
    Search for articles by this author
      Purpose: Bioabsorbable interference screw design may influence biomechanical characteristics. This study compared the insertion torque and load at failure characteristics of 2 types of screws during retrograde fixation of a soft-tissue graft. Type of Study: Biomechanical study. Methods: Eight matched pairs of doubled 100-mm long tibialis anterior allografts were prepared and fixed in appropriately sized tunnels created in 10 lb/ft3 (0.16 g/cm3) dense synthetic bone blocks using screws of similar length and root and thread diameter designed with either a large buttress thread with a smaller taper or small buttress thread with a larger taper. Insertion torque was measured at one-third, two-thirds, and full screw insertion. After the graft fixation constructs were mounted in a servohydraulic-testing device with the loading axis aligned directly with the tunnel and preloaded to 25 N, they were cycled 3 times from 0 to 50 N, and then subjected to a 20 mm/minute traction force to failure. Results: All constructs failed by graft slippage past the screw. Mean maximum load at failure (360.5 ± 68 N v 341.6 ± 58 N, P = .2) and stiffness (63.6 ± 16 N/mm2 v 66.4 ± 14 N/mm2, P = .89) was similar between constructs fixed with a large buttress thread small-taper screw and small buttress thread large-taper screw, respectively. The small buttress thread screw with a large taper displayed greater mean insertion torque at one-third insertion (4.1 ± 0.57 in-lb v 3.2 ± 0.49 in-lb, P = .03), whereas the large buttress thread screw with a small taper displayed greater mean insertion torque at full insertion (11.1 ± 0.74 in-lb v 9.4 ± 1.3 in-lb, P = .012). Mean differences were not observed at two-thirds screw insertion (P = .12). Conclusions: Large buttress thread small-taper screws displayed biomechanical fixation characteristics comparable to small buttress thread large-taper screws. Clinical Relevance: Given reports of superior screw-graft–bone tunnel contact area, these biomechanical results suggest that use of a large buttress screw with a small taper may be preferable for retrograde soft-tissue graft fixation.

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      References

        • Shino K.
        • Nakata K.
        • Horibe S.
        • Inoue M.
        • Nakagawa S.
        Quantitative evaluation after arthroscopic anterior cruciate ligament reconstruction. Allograft versus autograft.
        Am J Sports Med. 1993; 21: 609-616
        • Haut Donahue T.L.
        • Howell S.M.
        • Hull M.L.
        • Gregersen C.
        A biomechanical evaluation of anterior and posterior tibialis tendons as suitable single-loop anterior cruciate ligament grafts.
        Arthroscopy. 2002; 18: 589-597
        • Scranton P.E.
        • Lanzer W.L.
        • Ferguson M.S.
        • Kirkman T.R.
        • Pflaster D.S.
        Mechanisms of anterior cruciate ligament neovascularization and ligamentization.
        Arthroscopy. 1998; 14: 702-716
        • Selby J.B.
        • Johnson D.L.
        • Hester P.
        • Caborn D.N.
        Effect of screw length on bioabsorbable interference screw fixation in a tibial bone tunnel.
        Am J Sports Med. 2001; 29: 614-619
        • Caborn D.N.
        • Selby J.B.
        Allograft anterior tibialis tendon with bioabsorbable interference screw fixation in anterior cruciate ligament reconstruction.
        Arthroscopy. 2002; 18: 102-105
        • Brand Jr, J.C.
        • Pienkowski D.
        • Steenlage E.
        • Hamilton D.
        • Johnson D.L.
        • Caborn D.N.
        Interference screw fixation strength of a quadrupled hamstring tendon graft is directly related to bone mineral density and insertion torque.
        Am J Sports Med. 2000; 28: 705-710
        • Brown G.A.
        • Pena F.
        • Grontvedt T.
        • Labadie D.
        • Engebretsen L.
        Fixation strength of interference screw fixation in bovine, young human, and elderly human cadaver knees.
        Knee Surg Sports Traumatol Arthrosc. 1996; 3: 238-244
        • McGuire D.A.
        • Barber F.A.
        • Elrod B.F.
        • Elrod B.F.
        • Paulos L.E.
        Bioabsorbable interference screws for graft fixation in anterior cruciate ligament reconstructions.
        Arthroscopy. 1999; 15: 463-473
        • Nagarkatti D.G.
        • McKeon B.P.
        • Donahue B.S.
        • Fulkerson J.P.
        Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation.
        Am J Sports Med. 2001; 29: 67-71
        • Costi J.J.
        • Kelly A.J.
        • Hearn T.C.
        • Martin D.K.
        Comparison of torsional strengths of bioabsorbable screws for anterior cruciate ligament reconstruction.
        Am J Sports Med. 2001; 29: 575-580
        • Frankel V.H.
        • Burstein A.H.
        Orthopedic biomechanics. Lea & Febiger, Philadelphia1970
        • Muller M.E.
        • Allgower M.
        • Willenegger H.
        Manual of internal fixation. Springer-Verlag, Berlin1970
        • Uhthoff H.K.
        • Germain J.
        The reversal of tissue differentiation around screws.
        Clin Orthop. 1997; 123: 248-252
        • Uhthoff H.K.
        Mechanical factors influencing the holding power of screws in compact bone.
        J Bone Joint Surg Br. 1973; 55: 633-639
        • Morgan C.D.
        • Stein D.A.
        • Leitman E.H.
        • Kalman V.R.
        Anatomic tibial graft fixation using a retrograde bio-interference screw for endoscopic anterior cruciate ligament reconstruction.
        Arthroscopy. 2002; 18 (available online at www.arthroscopyjournal.org).: E38
        • Morgan C.D.
        • Kalman V.H.
        • Grawl D.
        Isometry testing for anterior cruciate ligament reconstruction revisited.
        Arthroscopy. 1995; 11: 647-659
        • Ishibashi Y.
        • Rudy T.
        • Livesay G.
        • Stone J.D.
        • Fu F.H.
        • Woo S.L.
        The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability.
        Arthroscopy. 1997; 13: 177-182
        • Weiler A.
        • Hoffman R.F.G.
        • Bail H.J.
        • Rehm O.
        • Sudkamp N.P.
        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.
        Arthroscopy. 2002; 18: 124-135
        • Barber F.A.
        Flipped patellar tendon autograft anterior cruciate ligament reconstruction.
        Arthroscopy. 2000; 16: 483-490
        • Scheffler S.U.
        • Sudkamp N.P.
        • Gockenjan A.
        • Hoffmann R.F.
        • Weiler A.
        Biomechanical comparison of hamstring and patellar tendon graft anterior cruciate ligament reconstruction techniques.
        Arthroscopy. 2002; 18: 304-315
        • Stadelmaier D.M.
        • Lowe W.R.
        • Ilahi O.A.
        • Noble P.C.
        • Kohl III, H.W.
        Cyclic pull-out strength of hamstring tendon graft fixation with soft tissue interference screws. Influence of screw length.
        Am J Sports Med. 1999; 27: 778-783
        • Weiler A.
        • Hoffmann R.F.
        • Siepe C.J.
        • Kolbeck S.F.
        • Sudkamp N.P.
        The influence of screw geometry on hamstring tendon interference fit fixation.
        Am J Sports Med. 2000; 28: 356-359
        • Weiler A.
        • Hoffmann R.
        • Stahelin A.C.
        • Bail H.J.
        • Siepe C.J.
        • Sudkamp N.P.
        Hamstring tendon fixation using interference screws.
        Arthroscopy. 1998; 14: 29-37
        • Arnoczky S.P.
        • Torzilli P.A.
        • Warren R.F.
        • Allen A.A.
        Biologic fixation of ligament prostheses and augmentations.
        Am J Sports Med. 1988; 16: 106-112
        • Firoozbakhsh K.K.
        • Moneim M.S.
        • DeCoster T.A.
        Pullout strength of power- and hand-driven staples in synthetic bone.
        J Orthop Trauma. 1992; 6: 43-49
        • McNamara B.P.
        • Cristofolini L.
        • Toni A.
        • Taylor D.
        Evaluation of experimental and finite element models of synthetic and cadaveric femora for pre-clinical design-analysis.
        Clin Materials. 1994; 17: 131-140
        • Noyes F.R.
        • Butler D.L.
        • Grood E.S.
        • Zernicke R.F.
        • Hefzy M.S.
        Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions.
        J Bone Joint Surg Am. 1984; 66: 344-352