title: Insertion torque pullout strength relationship of soft tissue tendon graft tibia tunnel fixation with a bioabsorbable interference screw.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the relationship between insertion torque and the biomechanical characteristics of soft tissue tendon graft tibia fixation with a bioabsorbable interference screw.
  
  
  METHODS
  Biomechanical study.
  
  
  METHODS
  Doubled tibialis anterior allografts (n = 20, length = 100 mm, diameter = 9 mm) prepared for anterior cruciate ligament (ACL) reconstructions were divided into 3 groups. Maximum insertion torque was measured as grafts were fixed by the same surgeon with a 10-mm diameter, 35-mm long screw in a 7-mm diameter tunnel (dilated to 9 mm) created in either 0.16 or 0.32 g/cm3 dense synthetic bone or cadaveric tibiae (0.84 +/- 0.15 g/cm2). Tensile testing to construct failure was then performed.
  
  
  RESULTS
  All constructs failed by tunnel pullout. Higher density synthetic bone had greater load at failure than lower density synthetic bone (486.6 +/- 83.8 v 271.6 +/- 52.6 N, P <.0001) and a slightly greater proportion of variance could be explained in synthetic bone (R2 = 0.74, P <.0001) than in cadaveric tibiae (R2 = 0.64, P =.017). Higher density synthetic bone displayed greater stiffness than lower density synthetic bone (68.1 +/- 21.6 v 37.7 +/- 11.2 N/mm, P =.012) and a higher proportion of variance could be explained in cadaveric tibiae (R2 = 0.72, P =.008) than in synthetic bone (R2 = 0.48, P =.012). Greater insertion torque levels were seen in higher density synthetic bone (2.97 +/- 0.35 v 1.24 +/- 0.06 Nm, P <.0001) than in lower density synthetic bone, and a higher proportion of variance could be explained in synthetic bone (R2 = 0.94, P <.0001) than in cadaveric tibiae (R2 = 0.74, P =.006).
  
  
  CONCLUSIONS
  Strong relationships were evident between insertion torque, bone mineral density (BMD) and load to failure across constructs. Differences between the synthetic bone groups and cadaveric tibiae, however, suggest the influence of mixed cortical and cancellous bone, nonuniform structural patterning, and differing BMD levels and distributions in the cadaveric tibiae.
  
  
  CONCLUSIONS
  Soft tissue graft tibial tunnel fixation is directly related to insertion torque and BMD. Synthetic models with mixed bone characteristics are needed to more accurately depict human tibiae during fixation testing.
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky 40202, USA. john.nyland@louisville.edu
authors.forename: John
authors.initials: J
authors.lastname: Nyland
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Kocabey
authors.forename: David N M
authors.initials: DN
authors.lastname: Caborn
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D015519:Bone Density; D001863:Bone Screws; D002417:Cattle; D004868:Equipment Failure; D006801:Humans; D008422:Materials Testing; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000601:surgery*; D019415:Torque; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous