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Bioabsorbable screw divergence angle, not tunnel preparation method influences soft tissue tendon graft-bone tunnel fixation in healthy bone

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Bone tunnel fixation of a soft tissue tendon graft is the weak link immediately following ACL reconstruction. This biomechanical study evaluated the influence of extraction drilled or step dilated bone tunnels and bioabsorbable screw divergence on soft tissue tendon graft fixation. From an initial group of 50 available specimens, similar apparent bone mineral density porcine tibiae (1.2 ± 0.24 g/cm2) were divided into two groups of ten specimens each. Group 1 (extraction drilled) received 9 mm diameter tunnels. Group 2 (step dilated) received 7 mm diameter tunnels that were dilated to 9 mm. Grafts were secured in tunnels using 10 mm diameter, 35 mm long tapered screws. After high resolution CT scanning to evaluate screw divergence, constructs were pretensioned on a servo hydraulic device between 10 and 50 N for 10 cycles, and isometric pretensioned at 50 N for 1 min, prior to 500 sub-maximal loading cycles (50–200 N) and load to failure testing at 20 mm/min. Wilcoxon Signed Rank tests and Mann–Whitney U-tests were used to evaluate group differences. Coefficient of determination values (r 2) were calculated to further delineate statistically significant relationships. Tunnel preparation method did not display statistically significant effects on insertion torque, displacement during cyclic testing, relative stiffness during cyclic testing, load at failure, stiffness during load to failure testing or displacement during load to failure testing. Screw divergence < 15° produced lower displacement and greater relative stiffness during cyclic testing and greater load at failure and stiffness during load to failure testing. Screw divergence angle displayed moderate relationships with construct displacement during cyclic testing (r 2 = 0.54), stiffness during load to failure testing (r 2 = 0.60), and load at failure (r 2 = 0.41). Tunnel dilation does not enhance soft tissue tendon graft fixation strength in healthy bone. Bioabsorbable screw divergence of ≥ 15° significantly reduces soft tissue tendon graft-bone tunnel fixation.

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Acknowledgments

Thanks for the support provided by the University of Louisville Summer Scholars Program and Arthrex Inc. Also, thanks to Seid Waddell and Dr. Mike Voor for their technical assistance.

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Authors and Affiliations

  1. Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY, 40202, USA

    Andrew R. Duffee, Jeffrey A. Brunelli, John Nyland, Robert Burden, Akbar Nawab & David Caborn

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  1. Andrew R. Duffee
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  2. Jeffrey A. Brunelli
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  3. John Nyland
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  4. Robert Burden
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  5. Akbar Nawab
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  6. David Caborn
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Correspondence to John Nyland.

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Duffee, A.R., Brunelli, J.A., Nyland, J. et al. Bioabsorbable screw divergence angle, not tunnel preparation method influences soft tissue tendon graft-bone tunnel fixation in healthy bone. Knee Surg Sports Traumatol Arthr 15, 17–25 (2007). https://doi.org/10.1007/s00167-006-0116-8

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  • DOI: https://doi.org/10.1007/s00167-006-0116-8

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