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J Knee Surg 2013; 26(03): 155-160
DOI: 10.1055/s-0032-1324808
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Interference Screw Fixation on ACL Graft Tensile Strength

Gregory A. Sawyer
1   Department of Orthopaedic Surgery, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island
,
Brett C. Anderson
2   Department of Orthopaedic Surgery and Sports Medicine, United States Air Force Academy, Colorado Springs, Colorado
,
David Paller
1   Department of Orthopaedic Surgery, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island
,
Wendell Malcolm Rogan Heard
3   Department of Orthopaedic Surgery and Sports Medicine, Rush University Medical Center, Chicago, Illinois
,
Paul D. Fadale
1   Department of Orthopaedic Surgery, Brown Medical School, Rhode Island Hospital, Providence, Rhode Island
› Author Affiliations
Further Information

Publication History

21 November 2011

27 June 2012

Publication Date:
21 September 2012 (online)

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Abstract

Tibial-sided fixation of soft tissue grafts in anterior cruciate ligament (ACL) reconstruction has often been identified as the weak link in the fixation construct, with interference screws being a commonly used technique. A significant concern surrounding the use of interference screws for soft tissue fixation is graft laceration and the possibility of loss of pull-out strength and slippage. The act of interference screw insertion for soft tissue graft fixation in ACL reconstruction alters the biomechanical properties of the graft. Two groups of 12 porcine knees (24 total) were utilized for the tibial-sided fixation of porcine flexor digitorum tendons using single-insertion interference screws, in a model of soft tissue ACL reconstruction. Two different screw types were used for comparison. Following screw insertion, the grafts were dissected free and underwent biomechanical testing in tension to failure. Control flexor digitorum tendons underwent the same biomechanical testing for comparison. Control soft tissue grafts exhibited significantly higher yield load, ultimate load, and stiffness (p < 0.001) in comparison to both groups of treated grafts, without evidence of significant macroscopic damage. Single insertion of interference screws for soft tissue graft fixation in ACL reconstruction weakens the biomechanical properties of the graft itself.

Keywords

anterior cruciate ligament - reconstruction - laceration - interference screw
 

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