title: Influence of Different Tibial Fixation Techniques on Initial Stability in Single-Stage Anterior Cruciate Ligament Revision With Confluent Tibial Tunnels: A Biomechanical Laboratory Study.
abstract: OBJECTIVE
  To kinematically and biomechanically compare 4 different types of tibial tunnel management in single-stage anterior cruciate ligament (ACL) revision reconstruction with the control: primary ACL reconstruction using a robotic-based knee testing setup.
  
  
  METHODS
  Porcine knees and flexor tendons were used. One hundred specimens were randomly assigned to 5 testing groups: (1) open tibial tunnel, (2) bone plug technique, (3) biodegradable interference screw, (4) dilatation technique, and (5) primary ACL reconstruction. A robotic/universal force-moment sensor testing system was used to simulate the KT-1000 (MEDmetric, San Diego, CA) and pivot-shift tests. Cyclic loading and load-to-failure testing were performed.
  
  
  RESULTS
  Anterior tibial translation increased significantly with all of the techniques compared with the intact ACL (P < .05). In the simulated KT-1000 test, groups 2 and 3 achieved results equal to those of primary ACL reconstruction (P > .05). The open tunnel and dilated tunnel techniques showed significantly greater anterior tibial translation (P < .05). The results of the simulated pivot-shift test were in accordance with those of the KT-1000 test. No significant differences could be observed regarding stiffness or maximum load to failure. However, elongation was significantly lower in the primary ACL reconstruction group compared with groups 1 and 3 (P = .02 and P = .03, respectively).
  
  
  CONCLUSIONS
  Filling an incomplete and incorrect tibial tunnel with a press-fit bone plug or a biodegradable interference screw in a standardized laboratory situation provided initial biomechanical properties and knee stability comparable with those of primary ACL reconstruction. In contrast, the dilatation technique or leaving the malplaced tunnel open did not restore knee kinematics adequately in this model. Backup extracortical fixation should be considered because the load to failure depends on the extracortical fixation when an undersized interference screw is used for aperture fixation.
  
  
  CONCLUSIONS
  Our biomechanical results could help orthopaedic surgeons to optimize the results of primary ACL revision with incomplete, incorrect tunnel placement.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Schliemann
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Treder
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schulze
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Viktoria
authors.initials: V
authors.lastname: Müller
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Vasta
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy.
authors.forename: Biaggio
authors.initials: B
authors.lastname: Zampogna
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Mirco
authors.initials: M
authors.lastname: Herbort
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Clemens
authors.initials: C
authors.lastname: Kösters
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Raschke
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany. Electronic address: simon.lenschow@ukmuenster.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Lenschow
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D007719:Knee Joint / Q000601:surgery; D016059:Range of Motion, Articular; D012086:Reoperation; D012371:Robotics; D013552:Swine; D013710:Tendons / Q000601:surgery; D013977:Tibia / Q000601:surgery*