Biomechanical comparison of screw osteosyntheses and anatomical plating for coronoid shear fractures of the ulna

Abstract Introduction Among the few techniques described for the treatment of coronoid fractures, osteosynthesis techniques include screw osteosynthesis from anterior to posterior (AP) or from posterior to anterior (PA) and plate osteosynthesis. The aim of this study was to test the biomechanical stability of screw osteosynthesis and plate osteosynthesis using anatomical plates in coronoid process fractures. Materials and methods On a total of 25 biomechanical synthetical ulnae, a coronoid shear fracture including 70% of the coronoid height was simulated. Osteosynthesis was then performed using two 2.7 mm screws from anterior, posterior and with use of three different anatomical plates of the coronoid process. For the biomechanical testing, axial load was applied to the fragment with 1000 cycles from 5 to 250 N, load to failure and load at 100 µm displacement. Displacements were measured using a point-based three-dimensional motion analysis system. Results Osteosynthesis using the PA-screw showed significant more displacement during cyclic loading compared with all other osteosyntheses (0.99 mm), whereas AP-screw showed the smallest displacement (0.10 mm) during cyclic loading. The PA-screw technique showed a significant lower load to failure compared to all other osteosynthesis with the highest load in AP-screw osteosynthesis. The load for 100 µm displacement was the smallest in PA-screw with a significant difference to the AP-screw and one plate osteosynthesis. Conclusion Osteosynthesis of large coronoid shear fractures with two small-fragment screws from anterior allows stable fixation that is not inferior to anterior plate osteosynthesis and might be an alternative in specific fracture types. Posterior screw fixation was found as the weakest fixation method. Level of evidence Basic science study

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Braided tape is equivalent to modified Mason-Allen multi-strand #2 suture in subscapularis muscle repair: results of a biomechanical study

Shoulder & Elbow ◽

10.1177/1758573216679945 ◽

2016 ◽

Vol 9 (2) ◽

pp. 85-91

Author(s):

Benjamin Léger-St-Jean ◽

Jérémie Ménard ◽

Stéphanie Hinse ◽

Frédéric Balg ◽

Dominique M Rouleau

Keyword(s):

Cyclic Loading ◽

Ultimate Load ◽

Tendon Repair ◽

Biomechanical Study ◽

Fixation Method ◽

Subscapularis Tendon ◽

Mineral Density ◽

Significant Difference ◽

Load To Failure ◽

The Mean

Background To help determine the optimal fixation method for subscapularis tendon repair in arthroplasty, the present study compares single-passage transosseous tape (BT) and modified Mason-Allen #2 suture (MA). Methods Eighteen human cadaveric shoulders were randomized to two repair constructs after arthroplasty preparation. Both techniques included two transosseous passages through the bicipital groove and then through the tendon at the level of the anatomical neck. Construct was tested using a traction machine, measuring cyclic loading and ultimate load to failure. Results The mean age of our specimens was 71 years. No significant difference was observed between the repair techniques in both mean ultimate load and cyclic loading. The mean (SD) ultimate load (UL) for BT was 293 (84) N and 342 (117) N for MA, which was not statistically significant ( p = 0.374). The majority of repairs failed in the tendon. Bone cut-out was observed with the MA but not for the BT repair. No correlation was found between bone density and UL for BT ( r = −0.09) but there was strong correlation for MA ( r = 0.63). Conclusions The MA repair appears to be more dependant on bone mineral density for ultimate load, indicating that braided-tape might be better suited for osteoporotic patients to avoid bone cut-out.

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How Many Proximal Screws Are Needed for a Stable Proximal Humerus Fracture Fixation?

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459321992744 ◽

2021 ◽

Vol 12 ◽

pp. 215145932199274

Author(s):

Hyojune Kim ◽

Myung Jin Shin ◽

Erica Kholinne ◽

Janghyeon Seo ◽

Duckwoo Ahn ◽

...

Keyword(s):

Cyclic Loading ◽

Proximal Humerus Fracture ◽

Locking Plate ◽

Proximal Humerus ◽

Humerus Fracture ◽

Proximal Fragment ◽

Maximum Displacement ◽

Significant Difference ◽

Load To Failure ◽

Screw Group

Purpose: This biomechanical study investigates the optimal number of proximal screws for stable fixation of a 2-part proximal humerus fracture model with a locking plate. Methods: Twenty-four proximal humerus fracture models were included in the study. An unstable 2-part fracture was created and fixed by a locking plate. Cyclic loading and load-to-failure tests were used for the following 4 groups based on the number of screws used: 4-screw, 6-screw, 7-screw, and 9-screw groups. Interfragmentary gaps were measured following cyclic loading and compared. Consequently, the load to failure, maximum displacement, stiffness, and mode of failure at failure point were compared. Results: The interfragmentary gaps for the 4-screw, 6-screw, 7-screw, and 9-screw groups were significantly reduced by 0.24 ± 0.09 mm, 0.08 ± 0.06 mm, 0.05 ± 0.01 mm, and 0.03 ± 0.01 mm following 1000 cyclic loading, respectively. The loads to failure were significantly different between the groups with the 7-screw group showing the highest load to failure. The stiffness of the 7-screw group was superior compared with the 6-screw, 9-screw, and 4-screw groups. The maximum displacement before failure showed a significant difference between the comparative groups with the 4-screw group having the lowest value. The 7-screw group had the least structural failure rate (33.3%). Conclusion: At least 7 screws would be optimal for proximal fragment fixation of proximal humerus fractures with medial comminution to minimize secondary varus collapse or fixation failure. Level of Evidence: Basic science study.

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Biomechanical Evaluation of Proximal Hamstring Repair: All-Suture Anchor Versus Titanium Suture Anchor

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119892925 ◽

2020 ◽

Vol 8 (1) ◽

pp. 232596711989292 ◽

Cited By ~ 1

Author(s):

Alexander Otto ◽

Alyssa M. DiCosmo ◽

Joshua B. Baldino ◽

Julian Mehl ◽

Elifho Obopilwe ◽

...

Keyword(s):

Cyclic Loading ◽

Suture Anchor ◽

Testing Machine ◽

Optical Tracking ◽

Rank Test ◽

Suture Anchors ◽

Posterior Aspect ◽

Significant Difference ◽

Load To Failure ◽

Proximal Hamstring

Background: Proximal hamstring avulsions are severe tendon injuries and are commonly sports-related. Open and endoscopic techniques as well as different anchor configurations have already been described for proximal hamstring repair. Novel all-suture anchors have been developed to provide decreased bone loss during placement and reduced occupied bone volume when compared with titanium suture anchors. Hypothesis: Complete proximal hamstring avulsions repaired with all-suture anchors will demonstrate equal load to failure and comparable displacement under cyclic loading when compared with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Complete proximal hamstring avulsions were created in 18 paired cadaveric specimens (mean ± SD age, 63.0 ± 10.4 years). Either all-suture anchors or titanium suture anchors were used for repair. Cyclic loading from 10 to 125 N at 1 Hz was performed for 1500 cycles with a material testing machine. Displacement was assessed along anterior and posterior aspects of the tendon repair with optical tracking. Specimens were loaded to failure at a rate of 120 mm/min. Displacement, load to failure, and repair construct stiffness were compared between matched pairs with the Wilcoxon signed-rank test. Correlations were determined by Spearman rho analysis. Results: The all-suture anchors showed significantly higher load-to-failure values when compared with the titanium anchor repairs (799.64 ± 257.1 vs 573.27 ± 89.9 N; P = .008). There was no significant difference in displacement between all-suture anchors and titanium suture anchors at the anterior aspect (6.60 ± 2.2 vs 5.49 ± 1.1 mm; P = .26) or posterior aspect (5.87 ± 2.08 vs 5.23 ± 1.37 mm; P = .678) of the repaired hamstring tendons. Conclusion: All-suture anchors demonstrated similar displacement and superior load to failure when compared with titanium suture anchors. Clinical Relevance: The results of this study suggest that all-suture anchors are an equivalent alternative to titanium suture anchors for proximal hamstring avulsion repair.

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Arthroscopic Treatment of Isolated Hoffa Fractures

The Journal of Knee Surgery ◽

10.1055/s-0037-1598108 ◽

2017 ◽

Vol 30 (08) ◽

pp. 842-848 ◽

Cited By ~ 5

Author(s):

Emre Baca ◽

Cemal Kural ◽

Ersin Ercin

Keyword(s):

Cruciate Ligament ◽

Case Series ◽

Significant Loss ◽

Meniscus Tear ◽

Fixation Method ◽

Level Of Evidence ◽

Significant Difference ◽

Functional Scores ◽

The Mean ◽

Postoperative Knee

AbstractThe goal of this study was to evaluate the results of a novel method, arthroscopic fixation of isolated Hoffa fractures.This is a prospective, case series and set at Level 1 trauma center. A total of eight patients with isolated Hoffa fractures who were operated by arthroscopic screw fixation method in the anterior posterior direction with 6.5 mm cannulated screws were followed up prospectively. Same surgical method used for all patients. All patients underwent the same rehabilitation program and active range of motion (ROM) exercises were started immediately. The International Knee Society (IKS) knee and functional scores, postoperative knee ROMs, and time of bone union were used as outcome measurements. Postoperative knee ROMs was compared with the contralateral healthy knee. The mean follow-up time was 29 months (26 − 41 months). At the final review, no significant difference (p = 0.159) was found between the ROM of healthy side and operated side of patients (153.1 ± 4.6 and 150 ± 3.8). The mean IKS knee and functional scores at 12 months were 87.2 ± 5.8 and 96.8 ± 3.7, respectively. Union was achieved in all patients at a mean duration of 3.8 months. Fracture side had no influence on the IKS knee scores, functional scores, and ROM (p = 0.846, p = 0.913, and p = 0.374, respectively). Concomitant intra-articular lesions identified in two patients (%25) during arthroscopy were one anterior cruciate ligament rupture and one medial meniscus tear. Patients undergoing arthroscopic Hoffa fracture fixation have excellent outcomes at average 29 months postoperatively with no apparent complications and no significant loss of ROM. Also 25% of patients had intra-articular injuries that were identified with arthroscopic technique that may have been missed with the open technique. The level of evidence was Level 4 (case series).

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Biomechanical Head-to-Head Comparison of 2 Sutures and the Giftbox Versus Bunnell Techniques for Midsubstance Achilles Tendon Ruptures

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117707477 ◽

2017 ◽

Vol 5 (5) ◽

pp. 232596711770747 ◽

Cited By ~ 8

Author(s):

Rufus O. Van Dyke ◽

Sejul A. Chaudhary ◽

Gregory Gould ◽

Roman Trimba ◽

Richard T. Laughlin

Keyword(s):

Cyclic Loading ◽

Achilles Tendon ◽

Biomechanical Testing ◽

Gap Formation ◽

Postoperative Rehabilitation ◽

Repair Technique ◽

Significant Difference ◽

Load To Failure ◽

Tendon Ruptures ◽

To Receive

Background: Acute midsubstance Achilles tendon ruptures are a common orthopaedic problem for which the optimal repair technique and suture type remain controversial. Head-to-head comparisons of current fixation constructs are needed to establish which stitch/suture combination is most biomechanically favorable. Hypothesis: Of the tested fixation constructs, Giftbox repairs with Fiberwire will exhibit superior stiffness and strength during biomechanical testing. Study Design: Controlled laboratory study. Methods: Two biomechanical trials were performed, isolating stitch technique and suture type, respectively. In trial 1, 12 transected fresh-frozen cadaveric Achilles tendon pairs were randomized to receive either the Giftbox-modified Krackow or the Bunnell stitch with No. 2 Fiberwire suture. Each repair underwent cyclic loading, oscillating between 10 and 100 N at 2 Hz for 1000 cycles, with repair gapping measured at 500 and 1000 cycles. Load-to-failure testing was then performed, and clinical and catastrophic failure values were recorded. In trial 2, 10 additional paired cadaveric Achilles tendons were randomized to receive a Giftbox repair with either No. 2 Fiberwire or No. 2 Ultrabraid. Testing and data collections protocols in trial 2 replicated those used in trial 1. Results: In trial 1, the Bunnell group had 2 failures during cyclic loading while the Giftbox had no failures. The mean tendon gapping after cyclic loading was significantly lower in the Giftbox repairs (0.13 vs 2.29 mm, P = .02). Giftbox repairs were significantly stiffer than Bunnell (47.5 vs 38.7 N/mm, P = .019) and showed more tendon elongation (5.9 ± 0.8 vs 4.5 ± 1.0 mm, P = .012) after 1000 cycles. Mean clinical load to failure was significantly higher for Giftbox repairs (373 vs 285 N, P = .02), while no significant difference in catastrophic load to failure was observed (mean, 379 vs 336 N; P = .61). In trial 2, there were no failures during cyclic loading. The Giftbox + Fiberwire repairs recorded higher clinical load-to-failure values compared with Giftbox + Ultrabraid (mean, 361 vs 239 N; P = .005). No other biomechanical differences were observed in trial 2. Conclusion: Simulated early rehabilitation biomechanical testing showed that Giftbox-modified Krackow Achilles repair technique with Fiberwire suture was stronger and more resistant to gap formation at the repair site than combinations that incorporated the Bunnell stitch or Ultrabraid suture. Clinical Relevance: A more in-depth understanding of the biomechanical properties of the Giftbox repair will help inform surgical decision making because stronger repairs are less likely to fail during accelerated postoperative rehabilitation.

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Proximal Hamstring Repair: A Biomechanical Analysis of Variable Suture Anchor Constructs

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118824149 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711882414 ◽

Cited By ~ 2

Author(s):

Michael B. Gerhardt ◽

Benjamin S. Assenmacher ◽

Jorge Chahla

Keyword(s):

Cyclic Loading ◽

Suture Anchor ◽

Failure Load ◽

Ultimate Failure Load ◽

Maximal Load ◽

Significant Difference ◽

Load To Failure ◽

Ultimate Failure ◽

Maximal Displacement ◽

Proximal Hamstring

Background: Despite an abundance of literature regarding construct strength for a myriad of anchors and anchor configurations in the shoulder, there remains a paucity of biomechanical studies detailing the efficacy of these implants for proximal hamstring repair. Purpose: To biomechanically evaluate the ultimate failure load and failure mechanism of knotless and knotted anchor configurations for hamstring repair. Study Design: Controlled laboratory study. Methods: A total of 17 cadaveric specimens divided into 3 groups composed of intact hamstring tendons as well as 2 different anchor configurations (all-knotted and all-knotless) underwent first cyclic loading and subsequent maximal loading to failure. This protocol entailed a 10-N preload, followed by 100 cycles incrementally applied from 20 to 200 N at a frequency of 0.5 Hz, and ultimately followed by a load to failure with a loading rate of 33 mm/s. The ultimate failure load and mechanism of failure were recorded for each specimen, as was the maximal displacement of each bone-tendon interface subsequent to maximal loading. Analysis of variance was employed to calculate differences in the maximal load to failure as well as the maximal displacement between the 3 study groups. Holm-Sidak post hoc analysis was applied when necessary. Results: The all-knotless suture anchor construct failed at the highest maximal load of the 3 groups (767.18 ± 93.50 N), including that for the intact tendon group (750.58 ± 172.22 N). There was no statistically significant difference between the all-knotless and intact tendon groups; however, there was a statistically significant difference in load to failure when the all-knotless construct was compared with the all-knotted technique (549.56 ± 20.74 N) ( P = .024). The most common mode of failure in both repair groups was at the suture-tendon interface, whereas the intact tendon group most frequently failed via avulsion of the tendon from its insertion site. Conclusion: Under biomechanical laboratory testing conditions, proximal hamstring repair using all-knotless suture anchors outperformed the all-knotted suture anchor configuration with regard to elongation during cyclic loading and maximal load to failure. Failure in the all-knotted repair group was at the suture-tendon interface in most cases, whereas the all-knotless construct failed most frequently at the musculotendinous junction. Clinical Relevance: No biomechanical studies have clearly identified the optimal anchor configuration to avert proximal hamstring repair failure. Delineating this ideal suture anchor construct and its strength compared with an intact hamstring tendon may alter the current standards for postoperative rehabilitation, which remain extremely conservative and onerous for these patients.

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Arthroscopic versus Open MTP Arthrodesis

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000209 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002 ◽

Cited By ~ 1

Author(s):

Kenneth Hunt ◽

Alastair Younger ◽

Richard Fuld ◽

Judas Kelley ◽

Nicholas Anderson ◽

...

Keyword(s):

Cyclic Loading ◽

Matched Pair ◽

Preparation Technique ◽

Locked Plate ◽

Plate Group ◽

Low Profile ◽

Significant Difference ◽

Load To Failure ◽

New Generation ◽

Biomechanical Strength

Category: Midfoot/Forefoot Introduction/Purpose: Hallux metatarsophalangeal (MTP) arthrodesis is a common procedure for painful conditions of the great toe. Dorsal plate fixation for MTP arthrodesis using locked plates produces good clinical outcomes and superior biomechanical strength to other techniques. However, arthroscopic fusion with new generation full thread compression screws is emerging as an alternative to open fusion. This method has been utilized clinically with good outcomes, but the biomechanical strength of arthroscopic MTP fusion fixation techniques is unknown. The purpose of this study was to compare low profile contoured locked plates to new generation full thread compression screws for first MTP fusion, in a biomechanical cadaver model. We hypothesize that there will be no significant difference in plantar gapping during cyclic loading, stiffness, or load-to-failure between the two groups, Methods: The first rays of eight matched pairs of fresh frozen cadaveric feet underwent dissection and DEXA scanning to measure bone mineral density (BMD). The “plate” group was prepared with cup-and-cone reamers, and fixation of the MTP joint with one compression screw and low profile dorsal locked plate. The matched pair “screws” group was prepared through a simulated arthroscopic technique, achieving fixation with two new generation full-thread compression screws, while preserving capsular attachments. Each specimen was loaded on the proximal phalanx in a cantilever fashion to 90 N at 3 Hz for a total of 250,000 cycles. Plantar MTP gap was recorded using a calibrated extensometer; Load-to-failure testing was performed for all specimens that endured cyclical loading; and stiffness was calculated from the final load-to-failure. Data was analyzed with a Student’s T-Test, with significance set at p<.05. Pearson Correlation coefficient (r) was calculated for stiffness and load-to-failure vs. BMD. Results: The plate group demonstrated significantly more plantar gapping during cyclic loading. There was no significant difference in stiffness, 31.6 N/mm (plates) and 51.7 N/mm (screws) (p=0.24) or load-to-failure, 198.6 N (plates) and 290.1 N (screws) (p =.07). Two of 8 screws-only specimens, and 3 of 8 locked plate specimens failed during cyclic loading. These early failures, and stiffness and load-to-failure were highly correlated to BMD for plates (r=0.85 and r=0.62, respectively) and screws only (r=0.82 and r=0.94, respectively). Maximum metatarsal head width measured on lateral view was strongly correlated with load-to-failure and stiffness for both groups (r > 0.7). Conclusion: Arthroscopic hallux MTP arthrodesis utilizing full thread compression screws has similar mean stiffness and load-to- failure compared to a low-profile locking plate, with significantly less plantar gapping. These data, combined with advantages of the arthroscopic preparation technique, support an increased role of arthroscopic fusion in lieu of more invasive open plating techniques. The two preload failures of the screws-only cohort occurred in specimens with the lowest BMD, potentially indicating a clinical contraindication with this technique. BMD and metatarsal width may aid in predicting early failure such that appropriate fixation construct and more conservative post-operative protocols might improve results for these patients.

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Is suture comparable to wire for cerclage fixation? A biomechanical analysis

Shoulder & Elbow ◽

10.1177/1758573217735323 ◽

2017 ◽

Vol 11 (3) ◽

pp. 225-232 ◽

Cited By ~ 2

Author(s):

Scott E. Westberg ◽

Yves P. Acklin ◽

Siva Hoxha ◽

Cagri Ayranci ◽

Samer Adeeb ◽

...

Keyword(s):

Cyclic Loading ◽

Clinical Application ◽

Static Load ◽

Biomechanical Analysis ◽

Suture Materials ◽

Cerclage Wire ◽

Significant Difference ◽

Load To Failure ◽

Cyclic Displacement ◽

Over Time

Background Cerclage wire is the current standard for circumferential bone fixation. Advances in technology have improved modern sutures, allowing for expanded utility and broader application. The present study compared the strength and durability of cerclage fixation between modern suture materials and monofilament wire. Methods The Surgeon’s Knot, the Nice Knot and the Modified Nice Knot, were each tied using three separate suture materials: no. 2 FiberWire (Arthrex, Naples, FL, USA), no. 2 Ultrabraid (Smith & Nephew, Andover, MA, USA) and no. 5 Ethibond (Johnson & Johnson, Somerville, NJ, USA). These sutures were compared with monofilament wire. Sutures were secured around a fixed diameter using three additional half hitches, whereas a 1.2-mm (18 gauge) stainless steel monofilament wire was used for comparison. One fellow and one orthopaedic surgery resident each tied five trials with every knot/material combination. Samples were subjected to cyclic loading and quasi-static load testing. Respectively, cyclic displacement over time and load to failure were analyzed. Clinical failure (3 mm of cyclic displacement) and absolute failure (opening of the knot or material failure) were the outcomes of interest. Results During cyclic loading, Ethibond displaced significantly less over time compared to monofilament wire ( p < 0.003), whereas FiberWire showed no significant difference. Ultrabraid also behaved similar to wire, except displacing significantly more than wire only with the Surgeon’s Knot ( p = 0.02). During load to failure, Ethibond and FiberWire failed at significantly greater loads than monofilament wire ( p < 0.001), whereas Ultrabraid performed similar to wire. Knot types did not appear to impact the results. Conclusions High-performance sutures achieve superior results in biomechanical testing under cyclic and quasi-static load compared to monofilament wire, suggesting that they provide an alternative to wire for cerclage fixation with select clinical application. Biomechanical security of suture cerclage is dependent on suture material, although it is not altered significantly by choice of knot. An ex-vivo study with clinical application would further reinforce whether suture cerclage offers a valid alternative to wire cerclage.

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Single Pulley Double-strand Anchor Suture Fixation of the Coronoid Process in Terrible Triad of the Elbow Injury

10.21203/rs.3.rs-155381/v1 ◽

2021 ◽

Author(s):

Yih-Wen Tarng ◽

Kai-Cheng Lin

Keyword(s):

Suture Anchor ◽

Case Series ◽

Suture Technique ◽

Coronoid Process ◽

Fixation Method ◽

Type I ◽

Terrible Triad ◽

Level Of Evidence ◽

Elbow Injury ◽

Anchor Suture

Abstract Background: Terrible triad of the elbow injury is difﬁcult to manage, and the role of the coronoid process in instability is very important. We describe a simple, modified suture technique to fix a coronoid process fragment using suture anchor fixation.Methods: Eight patients (3 female and 5 male) with coronoid process injuries with the fragment involving <50% of the total height (Reagan-Morrey type I/II) in terrible triad of elbow injury were included. Patients were treated operatively via a lateral Kocher’s approach, and coronoid process fractures were repaired with a single pulley double-strand suture technique. Structures were addressed in a sequential fashion—the coronoid process, radial head, lateral ulnar collateral ligament.Results: All patients were treated with the single pulley double-strand anchor suture technique and the coronoid process fragment was found to be in good contact with the original avulsion site using the method. The final Mayo Elbow Performance Score was excellent (> 90) in 6 patients and good (between 85 and 89) in 2 patients.Conclusions: The single pulley double-strand suture tie method using a suture anchor is a less invasive and simpler fixation method for the repair of coronoid process fractures in patients with terrible triad of the elbow injuries, and results in good outcomes. Level of evidence: Level IV; Case Series; Treatment Study

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Effect of Skeletal Maturity on Fixation Techniques for Tibial Eminence Fractures

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211049476 ◽

2021 ◽

Vol 9 (11) ◽

pp. 232596712110494

Author(s):

Andrew P. Thome ◽

Ryan O’Donnell ◽

Steven F. DeFroda ◽

Brian H. Cohen ◽

Aristides I. Cruz ◽

...

Keyword(s):

Cyclic Loading ◽

Screw Fixation ◽

Skeletal Maturity ◽

Suture Technique ◽

Fixation Method ◽

Suture Fixation ◽

Skeletally Immature ◽

Tibial Eminence ◽

Fixation Group ◽

Load To Failure

Background: Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized. Purpose: To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens. Study Design: Controlled laboratory study. Methods: Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed. Results: Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; P = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; P = .08). Conclusion: These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness. Clinical Relevance: A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans.

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