title: Biomechanical testing of hybrid hamstring graft tibial fixation in anterior cruciate ligament reconstruction.
abstract: Hamstring tendon using quadrupled semitendinosus and gracilis autografts is a well-established technique for ACL reconstruction. However, several methods have been used for tibial fixation of the tendon graft. The purpose of this study was to compare the biomechanical characteristics of quadrupled hamstring graft tibial fixation using three different fixation methods. Nine matched pairs (18 specimens) of cadaver tibias were divided into three groups of six specimens. The first group was fixed with only a tapered 30-mm bioabsorbable screw (BIS), the second group was fixed first with a BIS and then the remaining tendon portion was additionally fixed with a titanium cortical screw and spike washer, and the third group was fixed with only a cortical screw and spike washer. A custom-made probe hook was mounted on a load cell (Interface, MFG, Scottsdale, AZ) to measure the ACL tension before and after the final tibial fixation. Group 2 displayed greater mean maximum load at failure than both groups 1 and 3 (p<0.05). The stiffness of the graft nearly doubled in group 2 compared to groups 1 and 3 (p<0.05). All specimens failed by slippage and pullout. Biomechanical testing with cadavers showed that a BIS and additional cortical screw and spike washer fixation to the distal hamstring tendon resulted in higher load at failure and stiffness compared to either BIS or cortical screw and spike washer fixation alone.
authors.affiliation: Department of Orthopaedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwon-Dong, Kangnam-Ku Seoul, Korea 135-710. coolshoulder@hotmail.com
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Yoo
authors.forename: Jin Hwan
authors.initials: JH
authors.lastname: Ahn
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Byung Kwan
authors.initials: BK
authors.lastname: Kim
authors.forename: Kui Won
authors.initials: KW
authors.lastname: Choi
authors.forename: Tae Soo
authors.initials: TS
authors.lastname: Bae
authors.forename: Chang Yang
authors.initials: CY
authors.lastname: Lee
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D002102:Cadaver; D006801:Humans; D008422:Materials Testing; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D013710:Tendons / Q000502:physiology / Q000637:transplantation*; D013977:Tibia / Q000601:surgery; D014025:Titanium; D016474:Weight-Bearing / Q000502:physiology
chemical_list: D014025:Titanium