Comparison of bioabsorbable suture anchor fixation on the tibial side for anterior cruciate ligament reconstruction using free soft tissue graft: experimental laboratory study on porcine bone.
OBJECTIVE
The use of graft tissue fixation using bioabsorbable interference screws (BISs) in anterior cruciate ligament (ACL) reconstruction offers various advantages, but limited pullout strength. Therefore, additional tibial fixation is essential for aggressive rehabilitation. We hypothesized that additional graft tissue fixation using bioabsorbable suture anchors (BSA) would provide sufficient pull-out strength.


METHODS
Twenty four fresh frozen porcine distal femur and patellar tendon preparations were used. All specimens were divided into three groups based on additional fixation methods: A, isolated BIS; B, BIS and BSA; and C, BIS and post cortical screw. Tensile testing was carried out under an axial load. Ultimate failure load and ultimate failure load after cyclic loading were recorded.


RESULTS
The ultimate failure loads after load to failure testing were 166.8 N in group A, 536.4 N in group B, and 438 N in group C; meanwhile, the ultimate failure loads after load to failure testing with cyclic loading were 140 N in group A, 466.5 N in group B, and 400 N in group C. Stiffness after load to failure testing was 16.5 N/mm in group A, 33.5 N/mm in group B, and 40 N/mm in group C. An additional BSA fixation resulted in a significantly higher ultimate failure load and stiffness than isolated BIS fixation, similar to post screw fixation.


CONCLUSIONS
Additional fixation using a BSA provided sufficient pullout strength for ACL reconstruction. The ultimate failure load of the BSA technique was similar to that of post cortical screws.
Department of Orthopedic Surgery, College of Medicine, Inha University, Incheon, Korea.
Myung Ku
MK
Kim
Department of Orthopedic Surgery, College of Medicine, Inha University, Incheon, Korea.
Suk In
SI
Na
Department of Orthopedic Surgery, College of Medicine, Inha University, Incheon, Korea.
Jong Min
JM
Lee
Department of Orthopedic Surgery, College of Medicine, Inha University, Incheon, Korea.
Ju Yong
JY
Park
D000818:Animals; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001863:Bone Screws; D053441:Suture Anchors; D013552:Swine
Anterior cruciate ligament reconstruction; graft; suture anchor; tissue fixation