title: Effect of pilot-hole size on the pullout strength of flexor digitorum longus transfer fixed with a bioabsorbable screw.
abstract: BACKGROUND
  Fixation of tendon transfers with a bioabsorbable interference-fit screw has several advantages over other fixation methods: decreased dissection, operative time, and blood loss; preservation of tendon length; no interference with radiographic studies; no need for implant removal; and no barrier to revision surgery. Whether strength of fixation is affected by the size of the pilot hole has not been established. The purpose of this study was to determine the effect of pilot hole size on the pullout strength of a flexor digitorum longus (FDL) tendon secured into a bone analog using a 5.5-mm bioabsorbable screw.
  
  
  METHODS
  Thirty FDL tendons were harvested from 15 cadaver specimens and secured into predrilled 4 x 4 x 4 cm bone cubes with a 5.5-mm Arthrex bioabsorbable screw (Arthrex, Naples, FL). The use of bone analog foam cubes ensured consistent porosity at the insertion site, eliminating the variations associated with varying bone densities of cadaver specimens. Pilot hole sizes studied were 5.0 mm, 5.5 mm, and 6.0 mm. Pullout tests were done with an servohydraulic testing frame (MTS, Eden Prairie, MN).
  
  
  RESULTS
  There was no significant difference (p = 0.4) between the pullout forces and stresses among the three pilot hole sizes. All specimens failed at the interface between the FDL and the bioabsorbable screw. In the 6.0-mm pilot hole group, there was a trend for increased pullout strength with increased tendon size.
  
  
  CONCLUSIONS
  With a bioabsorbable 5.5-mm screw used for FDL transfer, a pilot hole the same size or a half millimeter larger or smaller than the screw had no statistically significant effect on the strength of the construct, even with tendons of different sizes.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. Donleyb@ccf.org
authors.forename: Brian G
authors.initials: BG
authors.lastname: Donley
authors.forename: Clinton
authors.initials: C
authors.lastname: Jambor
authors.forename: Ahmet
authors.initials: A
authors.lastname: Erdermier
authors.forename: James
authors.initials: J
authors.lastname: Sferra
authors.forename: Peter
authors.initials: P
authors.lastname: Cavanagh
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013709:Tendon Transfer / Q000295:instrumentation* / Q000379:methods / Q000592:standards