Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3606–3610 | Cite as

Interference screw insertion angle has no effect on graft fixation strength for insertional Achilles tendon reconstruction

  • Ziying Wu
  • Hongyun Li
  • Shiyi Chen
  • Kui Ma
  • Shengkun Li
  • Peng Zhang
  • Yinghui Hua



To compare the effect of two interference screw insertion angles on the biomechanical properties of the insertional Achilles tendon (IAT) reconstruction.


Nine matched pairs of fresh-frozen human cadaveric Achilles tendon specimens were randomized to two groups with interference screw insertion angles of 60° and 120°. The IAT reconstruction was performed by fixing the graft tendon with the interference screw. Each specimen was loaded to failure. The load at failure, stiffness, and mode of failure were documented. Differences in load at failure and stiffness were analysed.


There was no statistically significant difference between the 60° and 120° groups for failure load (149.137 ± 20.836 versus 155.428 ± 28.343 N, respectively, n.s.) and stiffness (14.523 ± 2.824 N/mm versus 14.727 ± 2.192 N/mm, respectively, n.s.). The most common mode of failure was the graft pulling out of the bone tunnel when the screw broke.


Graft fixation at two different interference screw insertion angles for IAT reconstruction exhibited equivalent biomechanical performance. When performing this procedure, surgeons may choose the interference screw insertion angle based on personal preference.


Chronic Achilles tendon rupture Reconstruction Interference screw 



We thank Melissa Gibbons, PhD, from Liwen Bianji, Edanz Editing China (, for editing the English text of a draft of this manuscript.


The study was not supported by any funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no potential conflict of interest.

Ethical approval

The study was approved by the ethics committee of Fudan University and performed in accordance with the Declaration of Helsinki.

Informed consent

Patients were informed before their death, and they consented to conduct this cadaver research.


  1. 1.
    Abu Bakar MS, Cheng MH, Tang SM, Yu SC, Liao K, Tan CT, Khor KA, Cheang P (2003) Tensile properties, tension-tension fatigue and biological response of polyetheretherketone-hydroxyapatite composites for load-bearing orthopedic implants. Biomaterials 24:2245–2250CrossRefGoogle Scholar
  2. 2.
    Aune AK, Ekeland A, Cawley PW (1998) Interference screw fixation of hamstrings vs. patellar tendon grafts for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:99–102CrossRefGoogle Scholar
  3. 3.
    Björkman P, Sandelin J, Harilainen A (2015) A randomized prospective controlled study with 5-year follow-up of cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23:2353–2359CrossRefGoogle Scholar
  4. 4.
    Boileau P, Krishnan SG, Coste JS, Walch G (2002) Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy 18:1002–1012CrossRefGoogle Scholar
  5. 5.
    Bushnell BD, Byram IR, Weinhold PS, Creighton RA (2006) The use of suture anchors in repair of the ruptured patellar tendon: a biomechanical study. Am J Sports Med 34:1492–1499CrossRefGoogle Scholar
  6. 6.
    Caekebeke P, Corten K, Duerinckx J (2016) Distal biceps tendon repair: comparison of clinical and radiological outcome between bioabsorbable and nonabsorbable screws. J Shoulder Elbow Surg 25:349–354CrossRefGoogle Scholar
  7. 7.
    Dumbre Patil SS, Dumbre Patil VS, Basa VR, Dombale AB (2014) Semitendinosus tendon autograft for reconstruction of large defects in chronic Achilles tendonruptures. Foot Ankle Int 35:699–705CrossRefGoogle Scholar
  8. 8.
    Ettinger M, Werner-Lebeda T, Calliess T, Omar M, Becher C, Ezechieli M, Klintschar M, Petri M (2017) Femoral interference screw fixation of hamstring and quadriceps tendons for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 25:1241–1248CrossRefGoogle Scholar
  9. 9.
    Guclu B, Basat HC, Yildirim T, Bozduman O, Us AK (2016) Long-term results of chronic Achilles tendon ruptures repaired with V-Y tendon plasty and fascia turndown. Foot Ankle Int 37:737–742CrossRefGoogle Scholar
  10. 10.
    Higano M, Tachibana Y, Sakaguchi K, Goto T, Oda H (2013) Effects of tunnel dilation and interference screw position on the biomechanical properties of tendon graft fixation for anterior cruciate ligament reconstruction. Arthroscopy 29:1804–1810CrossRefGoogle Scholar
  11. 11.
    Hufeland M, Kolem C, Ziskoven C, Kircher J, Krauspe R, Patzer T (2015) The influence of suprapectoral arthroscopic biceps tenodesis for isolated biceps lesions on elbow flexion force and clinical outcomes. Knee Surg Sports Traumatol Arthrosc 25:3220–3228CrossRefGoogle Scholar
  12. 12.
    Kurtz SM, Devine JN (2007) PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 28:4845–4869CrossRefGoogle Scholar
  13. 13.
    Longo UG, Lamberti A, Maffulli N, Denaro V (2010) Tendon augmentation grafts: a systematic review. Br Med Bull 94:165–188CrossRefGoogle Scholar
  14. 14.
    Maffulli N, Ajis A (2008) Management of chronic ruptures of the Achilles tendon. J Bone Joint Surg Am 90:1348–1360CrossRefGoogle Scholar
  15. 15.
    Maffulli N, Longo UG, Spiezia F, Denaro V (2010) Free hamstrings tendon transfer and interference screw fixation for less invasive reconstruction of chronic avulsions of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc 18:269–273CrossRefGoogle Scholar
  16. 16.
    Maffulli N, Del Buono A, Spiezia F, Maffulli GD, Longo UG, Denaro V (2013) Less-invasive semitendinosus tendon graft augmentation for the reconstruction of chronic tears of the Achilles tendon. Am J Sports Med 41:865–871CrossRefGoogle Scholar
  17. 17.
    Mayr R, Heinrichs CH, Eichinger M, Coppola C, Schmoelz W, Attal R (2015) Biomechanical comparison of 2 anterior cruciate ligament graft preparation techniques for tibial fixation: adjustable-length loop cortical button or interference screw. Am J Sports Med 43:1380–1385CrossRefGoogle Scholar
  18. 18.
    Mascarenhas R, Saltzman BM, Sayegh ET, Verma NN, Cole BJ, Bush-Joseph C, Bach BR Jr (2015) Bioabsorbable versus metallic interference screws in anterior cruciate ligament reconstruction: a systematic review of overlapping meta-analyses. Arthroscopy 31:561–568CrossRefGoogle Scholar
  19. 19.
    Mazzocca AD, Burton KJ, Romeo AA, Santangelo S, Adams DA, Arciero RA (2007) Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 35:252–258CrossRefGoogle Scholar
  20. 20.
    Mermerkaya MU1, Atay OA, Kaymaz B, Bekmez S, Karaaslan F, Doral MN (2015) Anterior cruciate ligament reconstruction using a hamstring graft: a retrospective comparison of tunnel widening upon use of two different femoral fixation methods. Knee Surg Sports Traumatol Arthrosc 23:2283–2291CrossRefGoogle Scholar
  21. 21.
    Mullaney MJ, McHugh MP, Tyler TF, Nicholas SJ, Lee SJ (2006) Weakness in end-range plantar flexion after Achilles tendon repair. Am J of Sports Med 34:1120–1125CrossRefGoogle Scholar
  22. 22.
    Ortiz C, Wagner E, Mocoçain P, Labarca G, Keller A, Del Buono A, Maffulli N (2012) Biomechanical comparison of four methods of repair of the Achilles tendon. A laboratory study with bovine tendons. J Bone Joint Surg Br 94:663–667CrossRefGoogle Scholar
  23. 23.
    Stärke C, Winkelmann U, Glüge S, Becker R, Lohmann CH, Winkelmann U (2016) Interference screw fixation of free tendon grafts: significant time-dependent decrease of the initial contact forces. Knee Surg Sports Traumatol Arthrosc 24:2353–2358CrossRefGoogle Scholar
  24. 24.
    Suchenski M, McCarthy MB, Chowaniec D, Hansen D, McKinnon W, Apostolakos J, Arciero R, Mazzocca AD (2010) Material properties and composition of soft-tissue fixation. Arthroscopy 26:821–831CrossRefGoogle Scholar
  25. 25.
    Uquillas CA, Guss MS, Ryan DJ, Jazrawi LM, Strauss EJ (2015) Everything Achilles: knowledge update and current concepts in management: AAOS exhibit selection. J Bone Joint Surg Am 97:1187–1195CrossRefGoogle Scholar
  26. 26.
    Zhang AL, Lewicky YM, Oka R, Mahar A, Pedowitz R (2007) Biomechanical analysis of femoral tunnel pull-out angles for anterior cruciate ligament reconstruction with bioabsorbable and metal interference screws. Am J Sports Med 35:637–642CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Sports Medicine, Huashan HospitalFudan UniversityShanghaiChina

Personalised recommendations