A biomechanical comparison of repair techniques for anterior cruciate ligament tibial avulsion fracture under cyclic loading.
OBJECTIVE
Although several technical developments for arthroscopic treatment of anterior cruciate ligament (ACL) avulsion fracture have been reported, it remains unclear which fixation technique is most effective to obtain the best initial fixation strength. The objectives of this study were to compare the initial fixation strength in response to a cyclic tensile load between different fixation techniques for ACL avulsion fractures.


METHODS
Cadaveric biomechanical evaluation.


METHODS
Using 15 fresh-frozen cadaveric human knees, 3 different fixation techniques for noncomminuted ACL avulsion fractures were compared by measuring the anterior tibial translation (ATT) under 500 cycles of 0 to 100 N of anterior tibial load: (1) antegrade screw fixation, (2) retrograde screw fixation, and (3) pullout suture fixation.


RESULTS
The increase in the ATT after the cyclic loading for the pullout suture fixation (2.2 +/- 0.8 mm) was significantly larger than that for the antegrade screw fixation (1.0 +/- 0.2 mm). The ATT increase in the retrograde fixation group (2.0 +/- 0.6 mm) was not significantly different compared with the other groups.


CONCLUSIONS
All methods were effective and there was a slight biomechanical advantage to antegrade screw fixation over pullout suture fixation.


CONCLUSIONS
Antegrade screw fixation is more effective in obtaining initial rigid fixation than pullout suture fixation for ACL avulsion fractures.
Tsukada
Harehiko
H
Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan. hare103@hotmail.com
Ishibashi
Yasuyuki
Y
Tsuda
Eiichi
E
Hiraga
Yasuharu
Y
Toh
Satoshi
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D001863:Bone Screws; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D013718:Tensile Strength; D013978:Tibial Fractures / Q000601:surgery*; D016474:Weight-Bearing