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J Knee Surg
DOI: 10.1055/s-0044-1786007
Original Article

The Effect of Supplementary Staple Fixation on Biomechanical Properties of Soft Tissue Graft Tibial Fixation in Anterior Cruciate Ligament Reconstruction

Cem Yıldırım
1   Department of Orthopedics and Traumatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
,
Mehmet Demirel
2   Department of Orthopedics and Traumatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
,
Emre Koraman
3   Department of Orthopedics and Traumatology, Kadikoy Florence Nightingale Hospital, Demiroglu Bilim University School of Medicine, Istanbul, Turkey
,
Osman Görkem Muratoğlu
4   Department of Orthopedics and Traumatology, Istinye University Faculty of Medicine, Istanbul, Turkey
,
Fatih Yamak
5   Faculty of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
,
Süreyya Ergün Bozdağ
5   Faculty of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
,
Yavuz Kocabey
6   Department of Orthopedics and Traumatology, Kocabey Clinic, Istanbul, Turkey
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Abstract

This study aimed to test and compare the biomechanical properties of three tibial fixation methods of anterior cruciate ligament (ACL) tendon grafts under cyclic load and load-to-failure testing in the bovine proximal tibiae, comprising (1) staple fixation alone, (2) interference screw fixation alone, and (3) interference screw fixation with a supplementary staple. Twenty-four bovine tibiae used in the study were divided into three groups (eight proximal tibiae in each group) based on tibial fixation methods of ACL tendon grafts: group A (a spiked ligament staple alone), group B (a cannulated interference screw alone), and group C (a cannulated interference screw with a supplementary staple). Each graft fixation was exposed to cyclic loading conditions. Significant differences were determined in failure load among the three groups (p = 0.008). The mean failure load was significantly higher in group B (717.04 ± 218.51 N) than in group A (308.03 ± 17.22 N) (p = 0.006). No significant differences were observed among the groups regarding axial stiffness (p = 0.442). Cyclic displacement differed significantly among the three groups (p = 0.005). In pairwise comparisons, the mean cyclic displacement was significantly higher in group A (8.22 ± 3.24 mm) compared with group C (1.49 ± 0.41 mm) (p = 0.005). Failure displacement varied considerably among the groups (p = 0.037). Although group B (15.53 ± 6.43 mm) exhibited a greater mean failure displacement than both group A (4.9 ± 0.75 mm) and group C (8.84 ± 4.65 mm), these differences did not reach statistical significance (p = 0.602 and p = 0.329, respectively). Interference screw fixation alone and supplementary staple fixation have biomechanically similar characteristics in terms of initial strength and stiffness of tibial ACL soft tissue graft fixation. Regardless of staple use, an interference screw with the same diameter as the tibial tunnel can ensure sufficient tensile strength in tibial ACL graft fixation.

Keywords

anterior cruciate ligament - tibial fixation - soft tissue graft - tendon graft - supplementary staple fixation


Publication History

Received: 09 May 2023

Accepted: 26 March 2024

Article published online:
10 April 2024

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