Document Title: Nurmi-AJSM-Mar04a.shtml
Article Title: Interference Screw Fixation of Soft Tissue Grafts in Anterior Cruciate Ligament Reconstruction: Part 1 Effect of Tunnel Compaction by Serial Dilators Versus Extraction Drilling on the Initial Fixation Strength
Authors: Janne T. Nurmi, DVM, PhD*, Pekka Kannus, MD, PhD*, Harri Sievänen, ScD, Timo Järvelä, MD, PhD*, Markku Järvinen, MD, PhD*, and Teppo L. N. Järvinen, MD, PhD*
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: March 2004
Volume 32, pages 411-417
Keywords: soft-tissue grafting, graft anchorage

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)

Comments: This article deals with the AT (anterior tibialis) tendon graft, which is more commonly used in Europe/Scandinavia than in North America. Much of the points from this study apply to other soft-tissue grafts (such as the hamstring DLSTG graft). The authors found that serial dilation is not as good as standard extraction-type drilling. (This is a cadaver-type study.)

Background: Compaction of the bone-tunnel walls by serial dilation is believed to enhance the interference screw fixation strength of the soft tissue grafts in anterior cruciate ligament (ACL) reconstruction.

Hypothesis: Serial dilation enhances the fixation strength of soft tissue grafts in ACL reconstruction over extraction drilling.

Study Design: Randomized experimental study.

Methods: Initial fixation strength of the doubled anterior tibialis tendon grafts (fixed with a bioabsorbable interference screw) was assessed in 21 pairs of human cadaver tibiae with either serially dilated or extraction-drilled bone tunnels. The specimens were subjected to a cyclic-loading test, and those surviving were then tested using the single-cycle load-to-failure test.

Results: During the cyclic-loading test, there were 3 fixation failures in the serially dilated and 6 failures in the extraction-drilled specimens but no significant stiffness or displacement differences between the groups. In the subsequent load-to-failure test, the average yield loads were 473 ± 110 N and 480 ± 115 N for the 2 groups respectively (P = .97) and no difference with regard to stiffness or mode of failure.

Conclusions: Serial dilation does not increase the strength of interference fixation of soft tissue grafts in ACL reconstruction over extraction drilling.

Clinical Relevance: The results of this experiment do not support the use of serial dilators in ACL reconstruction.

Key Words: bone compaction • dilation • ACL • graft fixation • biomechanics

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