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Smaller diameter femoral tunnel biocomposite interference screws provide adequate fixation strength in anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate the effect of bioabsorbable interference screw diameter on the pullout strength and failure mode for femoral tunnel fixation in primary anterior cruciate ligament reconstruction (ACLR) at time zero fixation using bone-patellar tendon-bone (BTB) autograft in a cadaveric model.

Methods

Twenty-four fresh-frozen cadaveric knees were obtained from 17 different donors. Specimens were allocated to three different treatment groups (n = 8 per group) based on interference screw diameter: 6 mm, 7 mm, or 8 mm biocomposite interference screw. All specimens underwent dual energy X-ray absorptiometry (DEXA) scanning prior to allocation to ensure no difference in bone mineral density among groups (n.s.). All specimens underwent femoral-sided ACLR with BTB autograft. Specimens subsequently underwent mechanical testing under monotonic loading conditions to failure. The load to failure and failure mechanism were recorded.

Results

The mean pullout force (N) at time zero for each group was 309 ± 213 N, 518 ± 313 N, and 541 ± 267 N for 6 mm, 7 mm, and 8 mm biocomposite interference screw diameter, respectively (n.s.). One specimen in the 6 mm group, two specimens in the 7 mm group, and one specimen in the 8 mm group failed by screw pullout. The remainder in each group failed by graft failure (n.s.).

Conclusion

Biocomposite interference screw diameter did not have a significant influence on fixation pullout strength or failure mode following femoral tunnel fixation using BTB autograft at time zero. A 6 mm interference screw can improve preservation of native bone stock, increase potential for biologic healing, and decrease the risk of damage to the graft during insertion without significantly compromising fixation strength. This study supports the use of smaller 6 mm interference screw diameter options for femoral tunnel fixation in ACLR.

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Availability of Data and Materials

The data generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to acknowledge Jay Bensusan, MS for his contribution to the mechanical testing and technical assistance throughout this study. We would also like to thank Arthrex, Inc (Naples FL) for providing grant funding (Grant US-19069) to assist with the completion of this study.

Funding

Arthrex, Inc. Grant US-19069.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, 11101 Euclid Ave, Cleveland, OH, 44106, USA

    Jason G. Ina, Derrick M. Knapik, Jacob G. Calcei & James E. Voos

  2. Case Western Reserve University School of Medicine, Cleveland, USA

    Mark F. Megerian

  3. Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, USA

    Clare M. Rimnac

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  1. Jason G. Ina
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Contributions

JI participated in conception of the study and study design, participated in surgeries, analyzed the data, performed statistical analysis, and drafted the manuscript. MM participated with the surgeries, analyzed the data, and assisted with drafting the manuscript. DK participated in conception of the study and study design and assisted with editing of the manuscript. JC participated with the surgeries and assisted with editing the manuscript, CR participated in conception of the study and study design, participated in the mechanical testing, and assisted with editing of the manuscript. JV participated in conception of the study and study design, performed the surgeries, and assisted with editing of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jason G. Ina.

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Conflict of interest

Jason Ina received a grant from Arthrex, Inc related to the submitted work. He also received education support from Rock Medical outside of the submitted work. Mark Megerian declares that they have no competing interest. Derrick Knapik received a grant from Arthrex, Inc related to the submitted work. He also received education support from Smith and Nephew and Medwest Associates, outside of the submitted work. Jacob Calcei declares that they have no competing interest. Clare Rimnac is a senior associate editor for Clinical Orthopaedics and Related Research. She also received a research grant and donor tissue from the Musculoskeletal Transplant Foundation, outside of the submitted work. James Voos received a grant from Arthrex, Inc related to the submitted work. He also is a consultant for Arthrex, outside of the submitted work.

Ethical approval

IRB exemption was obtained for the completion of this study.

Informed consent

No informed consent was required for the completion of this study.

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Ina, J.G., Megerian, M.F., Knapik, D.M. et al. Smaller diameter femoral tunnel biocomposite interference screws provide adequate fixation strength in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 31, 3434–3440 (2023). https://doi.org/10.1007/s00167-023-07421-z

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