title: Fixation strength of a novel bioabsorbable expansion bolt for patellar tendon bone graft fixation: an experimental study in calf tibial bone.
abstract: This biomechanical study compares the initial fixation strength of a novel bioabsorbable two-shell expansion bolt (EB) with that of a well-established interference-screw technique in bone-patellar tendon-bone (BPTB) reconstruction in a calf model. Thirty tibia plateaus (age 5-6 months) were assigned to three groups: In groups I and II, trapezoidal bone plugs of BPTB grafts were fixed with bioabsorbable poly-L-lactide interference screws (8 x 23 mm) or titanium interference screws (8 x 25 mm) respectively. In group III, semicircular grafts were fixed using bioabsorbable poly-D, L-lactide expansion bolts (5.8/8.7 x 10 x 35 mm). The tensile axis was parallel to the bone tunnel, and the construction was loaded until failure applying a displacement rate of 1 mm per second. In group II the mean ultimate loads to failure (713 N+/-218 N) were found to be significantly higher than those of groups I (487 N+/-205 N) and III (510 N+/-133 N). Measurement of stiffness showed 45 N/mm+/-13.3 in group I, 58 N/mm+/-17.4 in group II and 46 N/mm+/-6.9 in group III, and did not demonstrate significant differences. We found a correlation between insertion torque and wedge insertion force and ultimate loads to failure in all groups (r=0.53 in group I, r =0.54 in group II, and r =0.57 in group III). Cross-section planes of bone tunnel increased by 51%, 30% and 31% respectively, following insertion of screws or expansion of bolts (p<0.05). We conclude that ACL graft fixation by means of the presented expansion bolt demonstrates a fixation strength similar to the established bioabsorbable screw fixation, and is a reasonable alternative fixation method, especially since some of the specific pitfalls of screw fixation can be avoided.
authors.affiliation: Department of Orthopedic Trauma Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistrasse15, 81366 Munich, Germany. spiltz@med.uni-muenchen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Piltz
authors.forename: Patrick
authors.initials: P
authors.lastname: Strunk
authors.forename: Ludger
authors.initials: L
authors.lastname: Meyer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Plitz
authors.forename: Guenter
authors.initials: G
authors.lastname: Lob
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods; D002417:Cattle; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000295:instrumentation*; D010329:Patella / Q000601:surgery; D013710:Tendons / Q000601:surgery; D013977:Tibia / Q000601:surgery