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J Knee Surg 2020; 33(04): 365-371
DOI: 10.1055/s-0039-1677837
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Biomechanical Properties of Bioabsorbable Fixation for Osteochondral Shell Allografts

Dimitri M. Thomas
1   The Orthopedic and Sports Medicine Center, Anne Arundel Medical Center, Annapolis, Maryland
,
James P. Stannard
2   Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri Columbia, Columbia, Missouri
3   Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri Columbia, Columbia, Missouri
,
Ferris M. Pfeiffer
4   Department of Biological Engineering, University of Missouri, Columbia, Missouri
,
James L. Cook
2   Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri Columbia, Columbia, Missouri
3   Thompson Laboratory for Regenerative Orthopaedics, Missouri Orthopaedic Institute, University of Missouri Columbia, Columbia, Missouri
› Author Affiliations
Further Information

Publication History

19 October 2018

17 December 2018

Publication Date:
06 February 2019 (online)

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Abstract

This study compares bioabsorbable nail to metal screw fixation of shell osteochondral allograft (OCAs) for compression and shear strength. Cadaveric distal femurs (n = 5) yielding six 1.5 cm shell grafts (n = 30) were used. Three different fixation methods (2.0 and 2.4 mm headed screws, and copolymer absorbable nail) were compared for statistically significant differences (p < 0.05) in contact area, contact pressure, and shear load-to-failure. No significant differences in contact areas existed among groups (224 ± 33.5 mm2; 233.9 ± 20.8 mm2, 220.6 ± 22.7 mm2; p = 0.509 for 2.4, 2.0 mm screw, and nail, respectively). No significant differences in contact pressures existed (1.7 ± 0.6 MPa/mm2, 1.5 ± 0.8 MPa/mm2, 1.4 ± 0.9 MPa/mm2; p = 0.73 for 2.4, 2.0 mm screw, and nail, respectively). Load-to-failure for each was: 280.7 ± 48.4 N for 2.4 mm screws, 245.1 ± 70.6 N for 2.0 mm screws, and 215.2 ± 39.4 N for nails. There were no statistically significant differences in load-to-failure between 2.4 and 2.0 mm screws (p = 0.29) or between 2.0 mm screws and nails (p = 0.23); however, load-to-failure in shear was significantly higher for 2.4 mm screws compared with nails (p = 0.036). Fixation of shell OCAs using a copolymer headed nail provides initial graft-recipient compression similar to fixation using 2.0 and 2.4 mm headed screws. Nails failed in shear at significantly lower load than 2.4 mm screws but not 2.0 mm screws which have proven adequate for clinical healing. This study has clinical relevance, as a copolymer bioabsorbable headed nail (SmartNail) has graft-recipient compression and shear load-to-failure properties that suggest it is viable for shell OCA fixation.

Keywords

osteochondral allograft - shell allograft - osteochondral allograft fixation - PLLA implant - bioabsorbable pin
 

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