Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 12, pp 3982–3987 | Cite as

Biomechanical comparison of fixation techniques for medial collateral ligament anatomical augmented repair

  • Mohamed Omar
  • Maximilian Petri
  • Antonios Dratzidis
  • Simon El Nehmer
  • Christof Hurschler
  • Christian Krettek
  • Michael Jagodzinski
  • Max Ettinger
Experimental Study
First Online:
Received:
Accepted:

Abstract

Purpose

Although the majority of medial collateral ligament (MCL) ruptures can be treated conservatively with good results, some injuries require operative treatment. Besides MCL reconstruction, anatomical augmented repair may be considered. This study was to assess biomechanical properties of different fixation techniques regarding elongation and ultimate load to failure.

Methods

MCL anatomical augmented repair was simulated by fixation of porcine superficial digital flexor tendon grafts at porcine tibiae. Ten different fixation techniques were assessed. Fixation of the tendon graft was performed using 4.0-mm cancellous screws and either (1) 13.5-mm spiked polyether ketone (PEEK) washers; (2) 14-mm spiked washers; (3) 14-mm suture washers; (4) 14-mm customized washers; (5–8) combination of washers and No. 2 polyester sutures (FiberWire©); or using (9) single or (10) double 5.5-mm titanium suture anchors with No. 2 polyethylene sutures (Ultrabraid®). Biomechanical analysis included pretensioning of the constructs at 20 N for 30 s following cyclic loading of 250 cycles between 20 and 100 N at 1 Hz for measurement of elongation. Additionally, ultimate failure load and failure mode analysis were performed.

Results

Spiked PEEK washers secured with polyester sutures (5) yielded best biomechanical properties at time zero for both, elongation during cyclic loading (2.9 ± 0.7 mm) and ultimate failure load (469.8 ± 64.3 N).

Conclusions

These results suggest that spiked PEEK washers secured with polyester sutures are the most appropriate fixation technique for MCL anatomical augmented repair, thus providing best requirements to allow early knee mobilization and prevent secondary knee laxity.

Keywords

Knee Medial collateral ligament Washer Suture anchors Polyester sutures Biomechanics 
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Notes

Acknowledgments

The surgical materials for this study were donated by Arthrex (Naples, USA), Smith and Nephew (Tuttlingen, Germany) and Synthes (West Chester, USA).

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • Mohamed Omar
    • 1
  • Maximilian Petri
    • 1
  • Antonios Dratzidis
    • 2
  • Simon El Nehmer
    • 1
  • Christof Hurschler
    • 3
  • Christian Krettek
    • 1
  • Michael Jagodzinski
    • 1
  • Max Ettinger
    • 2
  1. 1.Trauma DepartmentHannover Medical SchoolHannoverGermany
  2. 2.Orthopaedic Surgery DepartmentHannover Medical SchoolHannoverGermany
  3. 3.Laboratory for Biomaterials and Biomechanics, Orthopaedic Surgery DepartmentHannover Medical SchoolHannoverGermany

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