Purpose
The purpose of this study was to develop a method of femoral fixation for complex
revision anterior cruciate ligament (ACL) reconstructions that would avoid a staged
bone grafting approach. We evaluated the use of a calcium phosphate cement as a structural
bone void filler that would allow for a single-stage revision ACL reconstruction with
initial biomechanical properties equivalent to standard autologous bone–patellar tendon–bone
primary ACL reconstruction.
Methods
We tested 11 matched pairs of fresh-frozen cadaveric knees (N = 22). Controls were
treated with autologous bone–patellar tendon–bone primary ACL reconstruction fixed
with bioabsorbable interference screws with a 1-mm back wall. The contralateral knee
of each pair had a large bone void created that would hamper subsequent femoral fixation
to simulate revision ACL reconstruction conditions. This defect was filled with calcium
phosphate cement arthroscopically. After solidification, the femoral tunnel was drilled
through the bone void filler and native bone with a 1-mm back wall, allowing anatomic
positioning. The autologous graft was then placed and fixed with a bioabsorbable interference
screw. Specimens were then tested in an MTS machine (MTS Systems, Eden Prairie, MN)
for load to failure according to a standard protocol and compared with matched controls.
Results
Failure loads for the control group averaged 312 N (standard deviation [SD], 127 N)
and were not significantly different compared with the calcium phosphate cement revision
group, which averaged 301 N (SD, 95 N) (P = .80). Failure occurred at the femoral bone block in both groups but without screw
pullout.
Conclusions
Statistical analysis failed to show a significant difference between the control group
and the group undergoing structural bone void filler revision in this biomechanical
evaluation of initial fixation strength.
Clinical Relevance
This technique may allow surgeons to perform a single-stage revision ACL reconstruction
in the presence of a contained bone void and avoid the need for a staged procedure
if clinical studies verify long-term incorporation of the bone void filler.
Key Words
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Article info
Publication history
Accepted:
April 9,
2009
Received:
October 6,
2008
Footnotes
Supported by a grant from the Department of Orthopaedic Surgery, Stanford University. The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
