Purpose
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.
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.
Results
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).
Conclusions
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.
Clinical Relevance
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.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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
Article info
Publication history
Published online: August 10, 2009
Accepted:
February 11,
2009
Received:
July 18,
2008
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
