Skip to main content

Advertisement

SpringerLink
Log in

A novel implant-free tibial pull-press-fixation for ACL reconstruction

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Extracortical fixation techniques in anterior cruciate ligament reconstruction bear the risk of tunnel enlargement, while close-to-aperture fixations often show lower failure loads. The purpose for this study was to investigate the biomechanical benefits of a novel implant-free combination of an extra-cortical and close-to-aperture fixation.

Materials and methods

Quadrupled human cadaveric semitendinosus tendons were fixed to 30 porcine tibiae with either a cannulated interference screw (I), an implant-free post-fixation (S), or a novel pull-press fixation (P). Specimens were cyclically loaded 20 times between 20 and 60 N followed by 500 cycles with 60–200 N, followed by a load-to-failure test with 1 mm/s.

Results

The mean elongation of the tendons in the P-group during the 500 cycles between 60 and 200 N was significantly lower (5.69 ± 2.16 mm) compared to 9.20 ± 3.21 mm in S-group and 9.37 ± 3.1 mm in the I-group (p < 0.05). The mean maximum load-to-failure was significantly higher in the P-group (728.2 ± 76.4 N) compared to 476.4 ± 68.8 N in the S-group and 625.9 ± 82.5 N in the I-group (p < 0.05). Stiffness of the constructs in the P-group was significantly higher (121.7 ± 44.9 N/mm) compared to 46.2 ± 17.7 N/mm in the S- and 72.8 ± 29.8 N/mm in the I-group (p < 0.03).

Conclusions

This study indicates superior biomechanical properties of a novel implant-free tibial pull-press fixation to conventional implant-free and close-to-aperture interference screw fixations in terms of cyclic elongation and maximum load-to-failure.

Level of evidence

Not applicable, basic science study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Clatworthy MG, Annear P, Bulow JU, Bartlett RJ (1999) Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 7(3):138–145. doi:10.1007/s001670050138

    Article  CAS  PubMed  Google Scholar 

  2. Ettinger M, Liodakis E, Haasper C, Hurschler C, Breitmeier D, Krettek C, Jagodzinski M (2012) Tibial press-fit fixation of flexor tendons for reconstruction of the anterior cruciate ligament. Unfallchirurg 115(9):811–815. doi:10.1007/s00113-010-1944-z

    Article  CAS  PubMed  Google Scholar 

  3. Fink C, Zapp M, Benedetto KP, Hackl W, Hoser C, Rieger M (2001) Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy 17(2):138–143. doi:10.1053/jars.2001.21509

    Article  CAS  PubMed  Google Scholar 

  4. Gartsman GM, Drake G, Edwards TB, Elkousy HA, Hammerman SM, O’Connor DP, Press CM (2013) Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study. J Shoulder Elbow Surg 22(11):1480–1487. doi:10.1016/j.jse.2013.06.020

    Article  PubMed  Google Scholar 

  5. Gianotti SM, Marshall SW, Hume PA, Bunt L (2009) Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 12(6):622–627. doi:10.1016/j.jsams.2008.07.005

    Article  PubMed  Google Scholar 

  6. Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G (2005) ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc 13(4):248–255

    Article  CAS  PubMed  Google Scholar 

  7. Hoffmann RF, Peine R, Bail HJ, Sudkamp NP, Weiler A (1999) Initial fixation strength of modified patellar tendon grafts for anatomic fixation in anterior cruciate ligament reconstruction. Arthroscopy 15(4):392–399

    Article  CAS  PubMed  Google Scholar 

  8. Hoher J, Moller HD, Fu FH (1998) Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 6(4):231–240. doi:10.1007/s001670050105

    Article  CAS  PubMed  Google Scholar 

  9. Jagodzinski M, Geiges B, von Falck C, Knobloch K, Haasper C, Brand J, Hankemeier S, Krettek C, Meller R (2010) Biodegradable screw versus a press-fit bone plug fixation for hamstring anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med 38(3):501–508. doi:10.1177/0363546509350325

    Article  PubMed  Google Scholar 

  10. Jagodzinski M, Scheunemann K, Knobloch K, Albrecht K, Krettek C, Hurschler C, Zeichen J (2006) Tibial press-fit fixation of the hamstring tendons for ACL-reconstruction. Knee Surg Sports Traumatol Arthrosc 14(12):1281–1287. doi:10.1007/s00167-006-0105-y

    Article  CAS  PubMed  Google Scholar 

  11. Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ, Tallroth K (1999) Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc 7(5):290–295

    Article  CAS  PubMed  Google Scholar 

  12. Kautzner J, Kos P, Hanus M, Trc T, Havlas V (2014) A comparison of ACL reconstruction using patellar tendon versus hamstring autograft in female patients: a prospective randomised study. Int Orthop. doi:10.1007/s00264-014-2495-7

    Google Scholar 

  13. Kousa P, Jarvinen TL, Vihavainen M, Kannus P, Jarvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part I: femoral site. Am J Sports Med 31(2):174–181

    PubMed  Google Scholar 

  14. Kousa P, Jarvinen TL, Vihavainen M, Kannus P, Jarvinen M (2003) The fixation strength of six hamstring tendon graft fixation devices in anterior cruciate ligament reconstruction. Part II: tibial site. Am J Sports Med 31(2):182–188

    PubMed  Google Scholar 

  15. Kwisda S, Dratzidis A, Ettinger M, Süzer F, Krettek C, Jagodzinski M (2013) A novel pull-press fixation: improved mechanical performance with any graft without hardware. Tech Orthop 28:176–179. doi:10.1097/BTO.0b013e3182995391

    Article  Google Scholar 

  16. L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5(4):234–238. doi:10.1007/s001670050056

    Article  PubMed  Google Scholar 

  17. Magen HE, Howell SM, Hull ML (1999) Structural properties of six tibial fixation methods for anterior cruciate ligament soft tissue grafts. Am J Sports Med 27(1):35–43

    CAS  PubMed  Google Scholar 

  18. Noyes FR, Barber-Westin SD (2001) Revision anterior cruciate ligament reconstruction: report of 11-year experience and results in 114 consecutive patients. Instr Course Lect 50:451–461

    CAS  PubMed  Google Scholar 

  19. Nurmi JT, Sievanen H, Kannus P, Jarvinen M, Jarvinen TL (2004) Porcine tibia is a poor substitute for human cadaver tibia for evaluating interference screw fixation. Am J Sports Med 32(3):765–771

    Article  PubMed  Google Scholar 

  20. Paessler HH, Mastrokalos DS (2003) Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press-fit fixation without hardware. A new and innovative procedure. Orthop Clin North Am 34(1):49–64

    Article  PubMed  Google Scholar 

  21. Seil R, Rupp S, Krauss PW, Benz A, Kohn DM (1998) Comparison of initial fixation strength between biodegradable and metallic interference screws and a press-fit fixation technique in a porcine model. Am J Sports Med 26(6):815–819

    CAS  PubMed  Google Scholar 

  22. Webster KE, Feller JA, Hameister KA (2001) Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 9(2):86–91

    Article  CAS  PubMed  Google Scholar 

  23. Weiler A, Hoffmann RF, Bail HJ, Rehm O, Sudkamp NP (2002) Tendon healing in a bone tunnel. Part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18(2):124–135

    Article  PubMed  Google Scholar 

  24. Weiler A, Hoffmann RF, Stahelin AC, Bail HJ, Siepe CJ, Sudkamp NP (1998) Hamstring tendon fixation using interference screws: a biomechanical study in calf tibial bone. Arthroscopy 14(1):29–37. doi:10.1016/S0749-8063(98)70117-3

    Article  CAS  PubMed  Google Scholar 

  25. Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH (2011) Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy 27(5):653–665. doi:10.1016/j.arthro.2011.01.015

    Article  PubMed  Google Scholar 

  26. Zantop T, Weimann A, Schmidtko R, Herbort M, Raschke MJ, Petersen W (2006) Graft laceration and pullout strength of soft-tissue anterior cruciate ligament reconstruction: in vitro study comparing titanium, poly-d, l-lactide, and poly-d, l-lactide-tricalcium phosphate screws. Arthroscopy 22(11):1204–1210. doi:10.1016/j.arthro.2006.06.015

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Sebastian Kwisda, Mohamed Omar, Maximilian Petri & Christian Krettek

  2. Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany

    Antonios Dratzidis & Max Ettinger

  3. Laboratory for Biomaterials and Biomechanics (LBB), Orthopaedic Surgery Department, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany

    Christof Hurschler

  4. Klinikum Schaumburg, Kreiskrankenhaus Stadthagen, Am Krankenhaus 1, 31655, Stadthagen, Germany

    Michael Jagodzinski

Authors
  1. Sebastian Kwisda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonios Dratzidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Max Ettinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed Omar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christof Hurschler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maximilian Petri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christian Krettek
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Michael Jagodzinski
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sebastian Kwisda.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kwisda, S., Dratzidis, A., Ettinger, M. et al. A novel implant-free tibial pull-press-fixation for ACL reconstruction. Arch Orthop Trauma Surg 135, 1547–1552 (2015). https://doi.org/10.1007/s00402-015-2293-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-015-2293-8

Keywords

Search

Navigation