This article reports the biomechanical demonstration of a technique for transtibial posterior cruciate ligament (PCL) reconstruction using a soft-tissue graft with cross-pin fixation in the tibia and compares this with the biomechanical properties achieved with other methods.
We used 5 paired cadaveric knees and another 10 tibias. Soft-tissue grafts were randomized. The femoral side of the anterior cruciate ligament was fixed with a Bio-TransFix device (Arthrex, Naples, FL) (group I), and the tibial side of the PCL was fixed with a Bio-TransFix device (group II). In another 10 tibias, tibial fixations were performed by use of a bio-interference screw (group III). Biomechanical testing was carried out on a testing machine, and maximal failure load, stiffness, and displacement were analyzed. The lengths of the slots of the TransFix device (Arthrex) from the near cortex were measured to compare the proper length of the device.
Maximal mean failure loads in groups I, II, and III were 549.3 ± 55.4 N, 570.8 ± 96.9 N, and 371.3 ± 106.2 N, respectively, showing a significant difference (P = .0003). Stiffnesses were 47.52 ± 16.84 N/mm, 59.14 ± 17.09 N/mm, and 27.60 ± 16.73 N/mm, respectively, showing a significant difference (P = .01). Mean displacements were 19.99 ± 5.79 mm, 19.09 ± 8.51 mm, and 17.58 ± 7.10 mm, respectively, showing no significant difference (P = .7535). The mean lengths of the slots of the TransFix device of the femurs and tibias were similar at 20.3 ± 1.25 mm and 20.2 ± 1.32 mm, respectively, showing no significant difference (P = .8637).
The transtibial technique by use of cross-pin tibial fixation with a Bio-TransFix device in PCL reconstruction provides stable fixation that is comparable to that achieved by use of conventional bio-interference screw fixation and femoral fixation in an anterior cruciate ligament reconstruction, an already well-established technique.
Biomechanically, tibial cross-pin fixation compares favorably with interference screw fixation and is useful when a graft is short. However, safety issues have not yet been resolved.
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- Posterior cruciate ligament reconstruction: Double-loop hamstring tendon autograft versus Achilles tendon allograft—Clinical results of a minimum 2-year follow-up.Arthroscopy. 2005; 21: 965-969
- Arthroscopic double-bundle augmentation of posterior cruciate ligament using split Achilles allograft.Arthroscopy. 2005; 21: 1436-1442
- Femoral bioabsorbable cross-pin fixation in anterior cruciate ligament reconstruction.Arthroscopy. 2007; 23: 1093-1099
- Current trends in anterior cruciate ligament reconstruction.Am J Sports Med. 2000; 28: 124-130
- Double-bundle anterior cruciate ligament reconstruction using two different suspensory femoral fixation: A technical note.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 1023-1027
- The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction.Am J Sports Med. 2003; 31: 182-188
- Transtibial double bundle posterior cruciate ligament reconstruction using TransFix tibial fixation.Knee Surg Sports Traumatol Arthrosc. 2007; 15: 973-977
- Mechanical properties of soft tissue femoral fixation devices for anterior cruciate ligament reconstruction.Am J Sports Med. 2004; 32: 635-640
- 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
- Mechanical analysis of fixation methods for anterior cruciate ligament reconstruction with hamstring tendon graft.Knee. 2005; 12: 135-138
- Cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons: Results of a controlled prospective randomized study with 2-year follow-up.Arthroscopy. 2005; 21: 25-33
- Intra-articular protrusion of malpositioned Transfix implant following anterior cruciate ligament reconstruction.Arthroscopy. 2006; 22: 226.e1-226.e4
- A pitfall of transfix fixation during anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2008; 16: 479-481
- Analysis and prevention of intra-operative complications of TransFix fixation in anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2008; 16: 639-644
- Histologic pattern of biomechanic properties of the carbon fiber-augmented ligament tendon.Clin Orthop Relat Res. 1985; : 5160
- Biomechanical testing of hybrid hamstring graft tibial fixation in anterior cruciate ligament reconstruction.Knee. 2006; 13: 455-459
- Biomechanical comparison of hamstring and patellar tendon graft anterior cruciate ligament reconstruction techniques: The impact of fixation level and fixation method under cyclic loading.Arthroscopy. 2002; 18: 304-315
- Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: A biomechanical analysis.Arthroscopy. 2006; 22: 660-668
- Biomechanics of cellular solids.J Biomech. 2005; 38: 377-399
- Comparison of failure strength between metallic and absorbable interference screws.Am J Sports Med. 1996; 24: 329-334
- Initial and 6 weeks postoperative structural properties of soft tissue anterior cruciate ligament reconstructions with cross-pin or interference screw fixation: An in vivo study in sheep.Arthroscopy. 2007; 23: 14-20
- Biomechanical properties of quadruple tendon and patellar tendon femoral fixation techniques.Knee Surg Sports Traumatol Arthrosc. 2001; 9: 337-342
Published online: August 10, 2009
Accepted: February 11, 2009
Received: July 18, 2008
The authors report no conflict of interest.
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.