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Close-looped graft suturing improves mechanical properties of interference screw fixation in ACL reconstruction

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

Abstract

Purpose

In anterior cruciate ligament reconstruction with looped soft-tissue grafts, an interference screw is frequently used for tibial fixation. This study compared three alternatives thought to improve the initial mechanical properties of direct bioabsorbable interference screw fixation: suturing the graft to close the loop, adding a supplementary staple, or increasing the oversize of the screw diameter relative to the bone tunnel from 1 to 2 mm.

Methods

Twenty-eight porcine tibiae and porcine flexor digitorum profundus tendons were randomized into four testing groups: a base fixation using 10-mm-diameter screw with open-looped graft, base fixation supplemented by an extracortical staple, base fixation but closing the looped graft by suturing its ends, and base fixation but using an 11-mm screw. Graft and bone tunnel diameters were 9 mm in all specimens. Constructs were subjected to cyclic tensile load and finally pulled to failure to determine their structural properties.

Results

The main mode of failure in all groups was pull-out of tendon strands after slippage past the screw. The sutured graft group displayed significantly lower residual displacement (mean value reduction: 47–67 %) and higher yield load (mean value increase: 38–54 %) than any alternative tested. No other statistical differences were found.

Conclusions

Suturing a soft-tissue graft to form a closed loop enhanced the initial mechanical properties of tibial fixation with a bioabsorbable interference screw in anterior cruciate ligament reconstructions using a porcine model, and thus, this may be an efficient means to help in reducing post-operative laxity and early clinical failure. No mechanical improvement was observed for an open-looped tendon graft by adding an extracortical staple to supplement the screw fixation or by increasing the oversize of the screw to tunnel diameter from 1 to 2 mm.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Laboratorio de Biomecánica, Departamento de Ingeniería Mecánica, Escuela de Ingenierías, Universidad de Malaga, C/Pedro Ortiz Ramos, s/n., 29071, Malaga, Spain

    María Prado, Ana Pérez-Blanca & Francisco Ezquerro

  2. Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Virgen de la Victoria, Campus Univ. Teatinos, s/n, 29010, Malaga, Spain

    Belén Martín-Castilla & José Miguel Serrano-Fernández

  3. Servicio de de Cirugía Ortopédica y Traumatología, Centro Hospitalario de Jaén, Ctra. Bailén-Motril, s/n., 23009, Jaén, Spain

    Alejandro Espejo-Reina

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  1. María Prado
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  2. Belén Martín-Castilla
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  3. Alejandro Espejo-Reina
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  4. José Miguel Serrano-Fernández
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  5. Ana Pérez-Blanca
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  6. Francisco Ezquerro
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Correspondence to Ana Pérez-Blanca.

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Prado, M., Martín-Castilla, B., Espejo-Reina, A. et al. Close-looped graft suturing improves mechanical properties of interference screw fixation in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 21, 476–484 (2013). https://doi.org/10.1007/s00167-012-1975-9

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  • DOI: https://doi.org/10.1007/s00167-012-1975-9

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