title: The biomechanics of biodegradable versus titanium interference screw fixation for anterior cruciate ligament augmentation and reconstruction.
abstract: OBJECTIVE
  The ligament augmentation and reconstruction system (LARS) is one of the options available for anterior cruciate ligament (ACL) reconstruction. To date, however, there are no published data regarding the biomechanical properties of LARS fixation for ACL reconstruction. The aim of this study was to investigate the biomechanical properties of various LARS interference-screw fixations.
  
  
  METHODS
  A total of 100 LARS ligaments were fixed in porcine femurs with five different interference screws (four biodegradable screws and one titanium interference screw) introduced from inside-out or extra-articularly outside-in. Each group consisted of ten specimens. The constructs were cyclically stretched and subsequently loaded until failure. We evaluated the maximum load before failure, elongation during cyclic loading, stiffness, and failure mode.
  
  
  RESULTS
  Elongation during cyclical loading for all devices tested was significantly larger between the first and 20th cycles than between the 20th and 500th cycles (p < 0.05). Maximum failure load was not significantly lower for the biodegradable screws than for the titanium screws (p > 0.05). All specimens failed because of ligament pull-out from the bony tunnel.
  
  
  CONCLUSIONS
  Our findings suggest that biomechanical secure fixation of the LARS for ACL reconstruction can be achieved using either biodegradable or titanium interference screws. The stability of fixation is independent of the approach, type of investigation, and type of fixation (extra-articular outside-in or intra-articular inside-out).
authors.affiliation: Department of Orthopaedic Surgery, Hannover Medical School, 1-7 Anna-von-Borries Street, Hannover, 30625, Germany, max.ettinger@ddh-gruppe.de.
authors.forename: Max
authors.initials: M
authors.lastname: Ettinger
authors.forename: Diana
authors.initials: D
authors.lastname: Schumacher
authors.forename: Tilman
authors.initials: T
authors.lastname: Calliess
authors.forename: Antonios
authors.initials: A
authors.lastname: Dratzidis
authors.forename: Marco
authors.initials: M
authors.lastname: Ezechieli
authors.forename: Christof
authors.initials: C
authors.lastname: Hurschler
authors.forename: Christoph
authors.initials: C
authors.lastname: Becher
mesh_terms: D020341:Absorbable Implants; D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D005269:Femur / Q000601:surgery; D008297:Male; D011475:Prosthesis Failure; D013552:Swine; D014025:Titanium / Q000627:therapeutic use*
chemical_list: D014025:Titanium