title: Pullout strength of a novel hybrid fixation technique (Tape Locking Screw™) in soft-tissue ACL reconstruction: A biomechanical study in human and porcine bone.
abstract: A novel hybrid anterior cruciate ligament (ACL) reconstruction technique known as Tape Locking Screw™ (TLS) is gaining popularity. Utilizing a suspension-type construct in conjunction with an interference screw, this technique has demonstrated successful initial clinical results with the use of quadruple hamstring graft. However, there is currently limited data available on the biomechanical strength of this fixation. This study investigates the pullout strength of the construct in human distal femora as well as in a porcine model. The construct is tested in isolation, without the use of any graft. We hypothesized that the pullout strength of this construct would be similar to or better than current fixation systems available.
  
  
  
  The Tape Locking Screw hybrid fixation system was implanted into twenty-two fresh frozen human distal femora (50-89 years old) randomized to 10×20mm titanium or polyether ether ketone (PEEK) screws by a single sports fellowship trained orthopedic surgeon. Given that the graft is secured to polyethylene terephthalate tape within the construct, the construct was implanted without any graft in order to isolate the device for biomechanical testing. After implantation, a tensile force was applied directly to the loop of tape at a loading rate of 5mm/min using an electromechanical testing system. The failure load was calculated from the resultant load-displacement curve. Specimens were then visually examined for mode of failure. Similar biomechanical tests were performed on sixteen porcine femora.
  
  
  
  In the human model, the mean pullout strength was 523±269N with the PEEK screw and 578±245N with the titanium screw. In the porcine femur model, mean strength was 616±177N with PEEK, 584±245N with titanium. There was no statistically significant difference in failure loads between these four groups. Tape slippage at the screw bone interface was the primary mode of failure in all the groups tested.
  
  
  
  Our results demonstrate that the hybrid technique provides excellent pullout strength in comparison to other soft-tissue ACL fixation methods, with tape slippage being the mode of failure in all specimens tested. This data, in addition to the advantages of the TLS system, support its consideration in the armamentarium of constructs available for soft-tissue ACL reconstruction.
  
  
  
  Laboratory controlled study level 2.
authors.affiliation: Einstein Medical Center, 5501 Old York Road, Willowcrest Building 4th Floor, Philadelphia, PA 19141, United States. Electronic address: ayzenbergm@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Ayzenberg
authors.affiliation: Einstein Medical Center, 5501 Old York Road, Willowcrest Building 4th Floor, Philadelphia, PA 19141, United States.
authors.forename: D
authors.initials: D
authors.lastname: Arango
authors.affiliation: Einstein Medical Center, 5501 Old York Road, Willowcrest Building 4th Floor, Philadelphia, PA 19141, United States.
authors.forename: G E
authors.initials: GE
authors.lastname: Gershkovich
authors.affiliation: Einstein Medical Center, 5501 Old York Road, Willowcrest Building 4th Floor, Philadelphia, PA 19141, United States.
authors.forename: P S
authors.initials: PS
authors.lastname: Samuel
authors.affiliation: Einstein Medical Center, 5501 Old York Road, Willowcrest Building 4th Floor, Philadelphia, PA 19141, United States.
authors.forename: M
authors.initials: M
authors.lastname: Saing
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation* / Q000379:methods; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D023421:Models, Animal; D013552:Swine; D013709:Tendon Transfer / Q000295:instrumentation*
keywords: Anterior cruciate ligament; Fixation; Hamstring; Pull out strength; TLS; Tape locking screw