A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction

TLDR

The study examined how different graft fixation methods affect the mechanical properties of ACL reconstructions. The authors tested six graft types on ten cadaveric knees, fixing tendons to femur and tibia using staples, suture buttons, or screws to create ACL substitutes. Results showed that reconstructed grafts failed at the fixation site, with the strongest performance seen in patellar tendon grafts secured by a large‑diameter cancellous screw, indicating fixation method is the key determinant of graft strength.

Abstract

Different surgical methods of graft fixation in ACL re construction were examined to determine the effects on mechanical properties of the reconstructed ACL. Ten human cadavers were used in this study. Six different types of grafts were studied. The tendon grafts were removed from each cadaver and fixed to femurs and tibias as ACL substitutes with different surgical fixation methods, leaving femur-reconstructed graft- tibia preparations. The surgical techniques used were staple fixation, tying sutures over buttons, and screw fixation. In the latter, the screws were introduced through femoral and tibial drill holes from the outside in order to achieve interference fit as described by Lam bert. Tensile testing demonstrated that the original ACL is significantly stronger than the graft used for recon struction in linear load, stiffness, and maximum tensile strength. All of the failures of the reconstructed ACL grafts occurred at the fixation site, indicating that the mechanically weak link of the reconstructed graft is located at the fixation site. Among the different meth ods of fixation, one-third of the patellar tendon secured with a cancellous screw, especially with a custom de signed large diameter screw, showed significantly higher values. Although many other factors affect the success of ACL reconstruction, our study indicates that the method of surgical fixation is the major factor influencing the graft's mechanical properties in the im mediate postoperative period.