Document Title: Magen-AJSM-Jan99

Article Title: Structural properties of six tibial fixation methods for anterior cruciate ligament soft-tissue grafts

Authors: Hugh E. Magen, Stephen M. Howell, Maury L. Hull.

Publication: The American Journal of Sports Medicine

ISSN: 03635465

Date: January-February 1999.

(Figures included. Reference-denoting numbers appear in the same point size as document text.)

Volume: 27

Issue: 1

Pages: 35-43

Key Words: Knee, ACL, ligaments, surgery, fixation, graft, sports medicine

 

This article discusses soft-tissue-type graft anchorage, as pertaining to hamstring-type (DLSTG) ACL grafts.

 

ABSTRACT

 

This study compared the stiffness (K), yield load (YL), and slippage (SL) of six tibial fixation methods. These properties were determined from load-to-failure and cyclic tests of double-looped tendon grafts fixed to both animal and young human tissue. Tandem washers (K = 259 N/mm, YL = 1159 N, SL = 0.5 mm) and the Washerloc (K = 248 N/mm, YL = 905 N, SL = 2.0 mm) were the two best fixations. At 500 N of load, which is the estimated daily tension of an anterior cruciate ligament graft during intensive rehabilitation, slippage was significantly greater in either of the other two methods for sutures tied to a post (4.9 mm), double staples (3.3 mm), and a 20-mm spiked metal washer (3.5 mm). Interference screw fixation performed well in animal tissue (YL = 776 N), but was significantly worse in young human tissue (YL = 350 N), with 57% of the fixations failing before 500 N of load. Animal tissue should not be used to estimate the performance of interference screw fixation in human tissue. Because 57% of the interference screw fixations using human tissue failed at loads below 500 N, their ability to provide adequate fixation during intensive rehabilitation should be questioned. However, both the Washerloc and tandem washers and screws provide fixation structural properties in young human tibia that should be appropriate for intensive rehabilitation.

 

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