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Biomechanical evaluation of a bioabsorbable expansion bolt for hamstring graft fixation in ACL reconstruction: an experimental study in calf tibial bone

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Abstract

Introduction: The purpose of our study was to evaluate and compare the primary fixation strength of a novel bioabsorbable two shell expansion bolt (EB) with that of a well-established interference screw-fixation technique in hamstring reconstruction of the anterior cruciate ligament. Materials and methods: Thirty calf tibia plateaus (age 5–6 months) were assigned to three groups: In group I (n=10) triple-stranded hamstring grafts were fixed with titanium interference screws (7 mm thread / 8 mm head × 25 mm). Specimens of group II (n=10) received bioabsorbable poly-L-lactide interference screws (8×23 mm). In group III (n=10), the grafts were fixed using bioabsorbable poly-D,L-lactide expansion bolts (5.8/8.5/10 mm × 35 mm). The tensile axis was placed parallel to the bone tunnel. The construction was then loaded until failure under a displacement rate of 1 mm per second. Results: There were no significant differences concerning the maximum pullout force (group I: 357 N  ± 61; group II: 326 N  ± 92; group III: 343 N  ± 55). In case of the expansion bolt, we found the stiffness to be higher (61 N/mm) when compared to group I (48 N/mm), and group II (52 N/mm) (P<0.01 I vs. III). Using interference screws, we were able to demonstrate a strong correlation between torque and pullout forces (group I: r2=0.7; group II: r2=0.92). Ruptures of the suturing material occurred only in groups I and II. Conclusion: We conclude that hamstring graft fixation, using the presented expansion bolt, demonstrates fixation strength similar to the established screw fixation and can therefore be regarded as a reasonable alternative fixation method. Especially, since some specific disadvantages of screw fixation can be prevented by application of the bolt fixation.

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Acknowledgements

The authors would like to thank Arthrex Inc., Naples, FL, USA and Smith&Nephew Inc., Carlsbad, CA, USA for providing us with the test implants. This study was supported by the University of Munich Research Fund, and by the Board of Editors of the Münchner Medizinische Wochenschrift.

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  1. Unfallchirurgie der Chirurgischen Klinik und Poliklinik – Großhadern, Klinikum der Universität München, Marchioninistr15, 81366, München, Germany

    S. Piltz, R. Dieckmann, L. Meyer, P. Strunk & G. Lob

  2. Labor für Biomechanik und Experimentelle Orthopädie, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistr.15, 81366, München, Germany

    W. Plitz

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Piltz, S., Dieckmann, R., Meyer, L. et al. Biomechanical evaluation of a bioabsorbable expansion bolt for hamstring graft fixation in ACL reconstruction: an experimental study in calf tibial bone. Arch Orthop Trauma Surg 125, 577–584 (2005). https://doi.org/10.1007/s00402-005-0007-3

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