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Comparison of outside-in and inside-out technique for tibial fixation of a soft-tissue graft in ACL reconstruction using the Shim technique

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

Abstract

Introduction

The aim of this study was to compare the biomechanical properties of tibial fixation of a free tendon graft in ACL reconstruction using the Shim, a new wedge-shaped implant, in an outside-in technique to fixation by the Shim used in an inside-out technique and fixation by interference screw in a porcine model.

Materials and methods

Porcine tibia and flexor tendons were used. In Group 1, the Shim was applied outside-in. In Group 2, the Shim was inserted inside-out. In the Group 3, an 8-mm interference screw was used. Ten specimens were tested in each group. Load-to-failure, elongation, stiffness and failure mode were recorded. Cyclic loading was performed between 5 and 250 N for 1,000 cycles, followed by a load to failure testing.

Results

Mean maximum load-to-failure was 629.53 N in Group 1,648.54 N in Group 2 and 749.53 N in Group 3. There was no significant difference between the groups. Stiffness varied between 127.34 N/mm in Group 1, 151.27 N/mm in Group 2 and 182.25 N/mm in Group 3. No significant differences were found between outside-in Shim and interference screw fixation. No significant difference was found for elongation among the three groups. The main failure mode was a rupture of the tendon in the IFS group and a slippage of either the implant or the tendon in both groups using the Shim.

Conclusions

As no statistically significant difference could be seen concerning load to failure, stiffness and elongation between the inside-out and the outside-in techniques, the Shim can be used for tibial fixation in an outside-in or inside-out technique depending on the preference of the surgeon. To prevent slippage of the graft a hybrid fixation should be considered.

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Authors and Affiliations

  1. Department of Trauma, Hand and, Reconstructive Surgery, Wilhelms University Muenster, Waldeyerstraße 1, 48149, Münster, Germany

    S. Lenschow, B. Schliemann, M. Schulze, M. Raschke & C. Kösters

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  1. S. Lenschow
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  2. B. Schliemann
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  3. M. Schulze
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  4. M. Raschke
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  5. C. Kösters
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Correspondence to S. Lenschow.

Additional information

S. Lenschow and B. Schliemann contributed equally to this study.

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Lenschow, S., Schliemann, B., Schulze, M. et al. Comparison of outside-in and inside-out technique for tibial fixation of a soft-tissue graft in ACL reconstruction using the Shim technique. Arch Orthop Trauma Surg 134, 1293–1299 (2014). https://doi.org/10.1007/s00402-014-2029-1

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  • DOI: https://doi.org/10.1007/s00402-014-2029-1

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