Yonsei Med J.  2014 May;55(3):760-765. 10.3349/ymj.2014.55.3.760.

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

• Kim MK
• Na SI
• Lee JM
• Park JY

• KMID: 2068688
• DOI: http://doi.org/10.3349/ymj.2014.55.3.760

Abstract

PURPOSE
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.
MATERIALS AND 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.
CONCLUSION
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.

Keyword

Anterior cruciate ligament reconstruction; graft; tissue fixation; suture anchor

MeSH Terms

Animals
Anterior Cruciate Ligament Reconstruction/*methods
Bone Screws
*Suture Anchors
Swine

Figure

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  Fig. 1 Graft preparation using Krackow whip stitches, forming four loops at each end of the tendon.

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  Fig. 2 Additional fixation devices used for this study. (A) 9×25 mm BioScrew®. (B) 6×16.5 mm Duet™. (C) 3.5 mm cortical screw.

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  Fig. 3 (A) Bioabsorbable suture anchor (Duet™). (B) Separated suture anchor tip and FiberWire® (Arthrex) connecting the tendon. (C) Reassembled bioabsorbable suture anchor.

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  Fig. 4 The 858 Table Top System® testing apparatus is shown with a porcine femur and graft. The free end of the patellar tendon graft was fixed to the inferior clamp of the machine with FiberWire®.

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  Fig. 5 Load elongation curve of the load to failure test (Elongation=EU-E0). UFL, ultimate failure load.

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  Fig. 6 Load elongation curve of the cyclic loading test (Elongation=E100-E0). UFL, ultimate failure load.

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