Primary stability of hamstring graft fixation with biodegradable suspension versus interference screws.
OBJECTIVE
During the early postoperative period, the stability of the fixation of a hamstring graft to the bone tunnel is the primary factor in limiting rehabilitation. The aim of this study was to evaluate if the initial fixation strength of a new suspension screw is comparable to that of the biodegradable interference screw fixation technique in the hamstring reconstruction of the anterior cruciate ligament (ACL).


METHODS
Experimental laboratory study.


METHODS
We evaluated the initial fixation strength of a biodegradable poly-L-lactide/tri-calcium phosphate (PLLA/TCP) screw that suspended the graft in the bone tunnel and compared it with the strength of an interference screw for fixation of hamstring grafts in ACL reconstruction using bovine knees. Single-cycle and cyclic loading tests were performed using a materials testing machine.


RESULTS
The suspension screw provided a significantly higher yield load and ultimate failure load than the interference screw. There was no significant difference in the stiffness of both techniques. The typical failure mode for the suspension screw was fracture of the screw and for the interference screw it was slippage of the graft past the screw. In cyclic testing, both methods of fixation ran out to 1,000 cycles up to 250 N with a mean displacement of 2.6 mm (range, 1.8 to 3.3 mm) for the suspension screw and 4.1 mm (range, 2.3 to 6.0 mm) for the interference screw. Only the grafts fixed with the suspension screw survived a protocol with 1,000 cycles up to 400 N.


CONCLUSIONS
Our biomechanical data suggest that hamstring graft fixation using a biodegradable PLLA/TCP suspension screw provides an alternative to interference screw fixation.


CONCLUSIONS
Hamstring graft fixation using a suspension screw provides a reasonable alternative to interference screw fixation.
Weimann
Andre
A
Department of Orthopaedic Surgery, Christian-Albrechts University Kiel, Kiel, Germany.
Rodieck
Mareike
M
Zantop
Thore
T
Hassenpflug
Joachim
J
Petersen
Wolf
W
D020341:Absorbable Implants; D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001696:Biomechanical Phenomena; D001863:Bone Screws / Q000145:classification*; D050376:Bone-Patellar Tendon-Bone Grafting / Q000295:instrumentation*; D002417:Cattle; D004867:Equipment Design; D019544:Equipment Failure Analysis; D066298:In Vitro Techniques; D018482:Muscle, Skeletal / Q000601:surgery*; D013314:Stress, Mechanical; D013718:Tensile Strength; D013977:Tibia / Q000601:surgery*; D016474:Weight-Bearing