Effect of the number of interference screws for the fixation of an intra-articular cranial cruciate ligament prosthesis in dogs: Biomechanical study

Abstract Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.

Download Full-text

Whether Sutures Reduce the Graft Laceration Caused by Interference Screw in Anterior Cruciate Ligament Reconstruction a Biomechanical Study in Vitro

10.21203/rs.3.rs-143941/v1 ◽

2021 ◽

Author(s):

Yuanjun Teng ◽

Lijun Da ◽

Xiaohui Zhang ◽

Hong Wang ◽

Hua Han ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Interference Screw ◽

Biomechanical Study ◽

Protective Effects ◽

Mineral Density ◽

Interference Screws ◽

Anterior Cruciate

Abstract Background: Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction However, previous studies h a d reported that the insertion of interference screws significantly caused graft laceration . The purpose of this study was to determine whether sutures reduce d the graft laceration from the insertion of interference screws in ACL reconstruction. Methods: Porcine tibias and bovine extensor tendons were used for establishing a knee model of ACL reconstruction in vitro . The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra high molecular weight polyethylene (UHMWPE) sutures Poly ether ether ketone (PEEK) interference screw s w ere used fortibial fixation Biomechanical tests were performed to investigate the protective effects of different sutures on grafts Results : All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre tension of the tendons, tibial bone mineral density) among all groups ( P 0.05). The biomechanical test s demonstrated that PEEK interference screw s significantly caused the graft laceration P 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction P 0.05). Conclusions : PEEK interference screw s significantly weakened the biomechanical properties of grafts during tibial fixation in ACL reconstruction. Absorbable Ethibond and UHMWPE sutures did not provide protective effects on grafts during ACL reconstruction.

Download Full-text

Does thread shape affect the fixation strength of the bioabsorbable interference screws for anterior cruciate ligament reconstructions? A biomechanical study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2435-1 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Gerardo L. Garcés ◽

Oscar Martel ◽

Alejandro Yánez ◽

Alberto Cuadrado

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Biomechanical Study ◽

Fixation Strength ◽

Interference Screws ◽

Anterior Cruciate

Download Full-text

The effect of tibial tuberosity advancement and meniscal release on kinematics of the cranial cruciate ligament-deficient stifle during early, middle, and late stance

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-10-08-0122 ◽

2011 ◽

Vol 24 (05) ◽

pp. 342-349 ◽

Cited By ~ 10

Author(s):

J. A. Syrcle ◽

R. M. McLaughlin ◽

S. H. Elder ◽

J. R. Butler

Keyword(s):

Cruciate Ligament ◽

Axial Rotation ◽

Biomechanical Study ◽

Tibial Tuberosity ◽

Rotational Stability ◽

Tibial Rotation ◽

Cranial Cruciate Ligament ◽

Rotational Displacement ◽

Treatment Conditions

SummaryObjectives: To evaluate the effect of tibial tuberosity advancement (TTA) and meniscal release on cranial-caudal and axial rotational displacement during early, middle and late stance phases in the canine cranial cruciate ligament- (CCL) deficient stifle.Study design: In vitro biomechanical study.Methods: Eighteen pelvic limbs were evaluated for the effects of TTA on cranial-caudal displacement and axial rotation under a load equivalent to 30% bodyweight, and under the following treatment conditions: normal (intact CCL), CCL deficient, TTA-treated (CCL deficient + TTA), and meniscal release (TTA treated + meniscal release). The limbs were evaluated in the early, middle, and late stance phases using electromagnetic tracking sensors to determine cranial tibial displacement and tibial rotation relative to the femur.Results: Transection of the CCL resulted in significant cranial tibial displacement during early, middle, and late stance (p < 0.0001) and significant internal rotation during early (p = 0.049) and middle stance (p = 0.0006). Performance of TTA successfully eliminated cranial tibial displacement in early, middle, and late stance (p <0.0001) however, the TTA was unsuccessful in normalizing axial rotation in middle stance (p = 0.030). Meniscal release had no effect on cranial-caudal or rotational displacement when performed in conjunction with the TTA.Clinical significance: Tibial tuberosity advancement effectively eliminates cranial tibial displacement during early, middle and late stance however, TTA failed to provide rotational stability in mid-stance.

Download Full-text

Effect of tibial insertion site for lateral suture stabilization on the kinematics of the cranial cruciate ligament deficient-stifle during early, middle and late stance

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-12-04-0051 ◽

2013 ◽

Vol 26 (03) ◽

pp. 208-217 ◽

Cited By ~ 6

Author(s):

T. A. Harper ◽

O. I. Lanz ◽

L. L. D'Amico ◽

J. R. Butler ◽

R. M. McLaughlin ◽

...

Keyword(s):

Tracking System ◽

Cruciate Ligament ◽

Insertion Site ◽

Three Dimensional ◽

Axial Rotation ◽

Biomechanical Study ◽

Lateral Direction ◽

Cranial Cruciate Ligament ◽

Lateral Suture

SummaryObjective: To evaluate the effect of two tibial attachment sites for lateral suture stabilization (LSS) on the three-dimensional femorotibial translational and rotational movements of the cranial cruciate ligament-deficient canine stifle during the early, middle and late stance phases.Study design: In vitro biomechanical study: 32 hindlimbs from 16 canine cadavers.Methods: Limbs were mounted in a testing jig and an electromagnetic tracking system was used to determine the three-dimensional femorotibial translational and rotational movements under 33% of body weight load during early, middle and late stance in the following sequence: cranial cruciate ligament-intact, cranial cruciate ligament-deficient and LSS with the distal anchor through the tibial tuberosity (LSSTT) or through the cranial eminence of the extensor groove (LSSEG). The proximal anchor point was the lateral femorofabellar ligament.Results: Post-LSS stifle three-dimensional femorotibial translational and rotational movements were more comparable to normal than post-transection movements for both techniques. Both LSS techniques restored femorotibial movements in cranial cruciate ligament-deficient stifles to varying amounts but neither technique successfully restored normal three-dimensional femorotibial movements. The LSSEG improved femorotibial movements of the cranial cruciate ligament-deficient stifle in the medial-lateral direction and axial rotation but performed poorly in restoring femorotibial movements in the cranial-caudal direction as compared to the LSSTT.Clinical significance: Both the LSSTT and LSSEG techniques failed to completely restore normal three-dimensional femorotibial translational and rotational movements in cranial cruciate ligament-deficient stifles in vitro.

Download Full-text

Tibial displacement with stifle joint flexion and cranial cruciate ligament transection in the dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-13-06-0080 ◽

2014 ◽

Vol 27 (04) ◽

pp. 277-284 ◽

Cited By ~ 1

Author(s):

Y. Hara ◽

S. Fukano ◽

H. Fujie ◽

H. Ochi ◽

Y. Fujita ◽

...

Keyword(s):

Ex Vivo ◽

Cruciate Ligament ◽

Three Dimensional ◽

Biomechanical Study ◽

Cranial Cruciate Ligament ◽

Compression Load ◽

Stifle Joint ◽

A Value ◽

Joint Flexion ◽

Robotic Simulator

Summary Objective: The aim of this study was to investigate the biomechanical effects of cranial cruciate ligament (CrCL) transection on stifle stability at three different stifle joint flexion angles using a robotic system. Methods: This was an ex vivo biomechanical study. Stifles (n = 6) were collected from the cadavers of Beagles weighing 10.5–12.0 kg. Six stifle joints were dissected, potted, and secured to the manipulator arms of a robotic simulator. With the stifle joint angle maintained at either hyperextension (151°), 135° or 90°, stability was assessed by application of a 50 N load in either the cranial-caudal (CrCd test) or proximal-distal (PD test) directions. The stifle was given a cranial-caudal load of 50 N (CrCd test). A proximal-distal compression load of 50 N was then administered by the manipulator (proximal-distal test: PD test). The change in three-dimensional kinematics of the intact and the CrCL-transected stifles was compared between hyperextension, and 135° and 90° flexion for the CrCd and PD load conditions. A value of p <0.05 was considered statistically significant. Results: The cranial tibial displacements in the PD tests of the CrCL-transected stifles at 135° (8.4 ± 1.2 mm) and at 90° (8.1 ± 1.9 mm) were significantly greater than the displacement at 151.5° (5.1 ± 1.6 mm) (p = 0.004 and p = 0.012 respectively). Clinical significance: The canine stifle exhibited the most instability when the stifle flexion angle was 135°.

Download Full-text

The effects of a novel lateral extracapsular suture system on the kinematics of the cranial cruciate deficient canine stifle

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-12-04-0055 ◽

2013 ◽

Vol 26 (04) ◽

pp. 271-279 ◽

Cited By ~ 11

Author(s):

O. I. Lanz ◽

K. S. Aulakh ◽

J. R. Butler ◽

R. M. McLaughlin ◽

T. A. Harper ◽

...

Keyword(s):

Body Weight ◽

Internal Rotation ◽

Relative Position ◽

Cruciate Ligament ◽

Biomechanical Study ◽

Electromagnetic Tracking ◽

Joint Angles ◽

Cranial Cruciate Ligament ◽

Significant Difference

SummaryObjective To evaluate the relative position of the femur and tibia in cranial cruciate ligament- intact stifles, cranial cruciate ligamentdeficient stifles, and cruciate-deficient stifles following lateral extracapsular suture system (LESS) stabilization under load at specific joint angles.Study design In vitro biomechanical study.Methods Twenty pelvic limbs from 11 dogs were used to evaluate the relative position of the femur and tibia between three stifle conditions (cranial cruciate ligament-intact, cranial cruciate ligament-deficient, and LESSstabilized) at a load of 30% of body weight and stifle angles of 125°, 135°, and 145° using electromagnetic tracking sensors.Results Cranial cruciate ligament-deficient stifles had significantly greater (p <0.0001) cranial displacement and internal rotation of the tibia relative to the femur than cranial cruciate ligament-intact or LESS stifles at all stifle angles. Cranial displacement of the tibia relative to the femur for cranial cruciate ligament-intact and LESS stifles were not significantly different from one another at a stifle angle of 125°, but were significantly different at stifle angles of 135° (p = 0.0182) and 145° (p = 0.0012). There was no significant difference in internal rotation of the tibia relative to the femur between the cranial cruciate ligament-intact and LESS stifles at any of the stifle angles.Clinical significance The LESS procedure effectively decreased cranial tibial displacement and eliminated internal rotation of the tibia relative to the femur in the cranial cruciate ligament-deficient stifles at stifle angles of 125°, 135°, and 145° in vitro.

Download Full-text

Fatigue Life of Superelastic Springs for an Anterior Cruciate Ligament Prosthesis

Journal de Physique IV (Proceedings) ◽

10.1051/jp4/1995581223 ◽

1995 ◽

Vol 05 (C8) ◽

pp. C8-1223-C8-1228

Author(s):

N. Hagemeister ◽

L'H. Yahia ◽

E. Weynant ◽

T. Lours

Keyword(s):

Anterior Cruciate Ligament ◽

Fatigue Life ◽

Cruciate Ligament ◽

Anterior Cruciate ◽

Ligament Prosthesis

Download Full-text

Determination of Graft Forces for Cranial Cruciate Ligament Reconstruction in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632524 ◽

1996 ◽

Vol 09 (04) ◽

pp. 165-171 ◽

Cited By ~ 1

Author(s):

D. A. Hulse ◽

M. R. Slater ◽

J. F. Hunter ◽

W. A. Hyman ◽

B. A. Shelley

Keyword(s):

Degrees Of Freedom ◽

Cruciate Ligament ◽

Insertion Site ◽

Graft Fixation ◽

Flexion Angle ◽

Patellar Ligament ◽

Graft Material ◽

Test Apparatus ◽

Cranial Cruciate Ligament ◽

Tibial Insertion

SummaryA test apparatus that allowed the stifle to move in five degrees of freedom was used to determine the effect of graft location, graft preload, and flexion angle at the time of graft fixation on the tensile graft forces experienced by a replacement graft material used to simulate reconstruction of the cranial cruciate ligament deficient stifle. Two graft locations (tibial insertion site of the patellar ligament and tibial insertion site of the cranial cruciate ligament), two graft preloads (5 N and 20 N), and three flexion angles at the time of graft fixation (15°, 30° and 90°) were examined. The tibial insertion site and preload did not have as great an effect on graft force as did the flexion angle of the limb at time of graft fixation. Graft forces were highest when reconstructions were performed with the limb in 90° of flexion (ρ <0.0001). This study supports the notion that intracapsular grafts should be fixed with the limb in a normal standing angle.A five degree of freedom test apparatus was used to evaluate the effect of graft location, graft preload, and limb flexion angle at time of graft fixation on reconstructions of the cranial cruciate ligament deficient stifle. Our results suggest that intracapsular grafts should not be fixed with the limb in 90° of flexion, but in a normal standing angle.

Download Full-text

An in vitro Comparison of Two Replacement Techniques Utilizing Fascia Lata after Cranial Cruciate Ligament Transection in the Dog

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1633025 ◽

1993 ◽

Vol 06 (02) ◽

pp. 85-92 ◽

Cited By ~ 3

Author(s):

G. L. Coetzee

Keyword(s):

Femoral Condyle ◽

Cruciate Ligament ◽

Maximum Load ◽

Fascia Lata ◽

Patellar Ligament ◽

Cross Sectional ◽

Cranial Cruciate Ligament ◽

Replacement Technique ◽

Over The Top

SummaryThe immediate postoperative biomechanical properties of an “underand-over” cranial cruciate ligament (CCL) replacement technique consisting of fascia lata and the lateral onethird of the patellar ligament, were compared with that of a modified intra- and extracapsular “under-and-over-the-top” (UOTT) method. The right CCL in twelve adult dogs was dissected out and replaced with an autograft. The contralateral, intact CCL served as the control. In group A, the graft was secured to the lateral femoral condyle with a spiked washer and screw. In group B the intracapsular graft was secured to the lateral femoro-fabellar ligament, and the remainder to the patellar tendon. Both CCL replacement techniques exhibited a 2.0 ± 0.5 mm anterior drawer immediately after the operation. After skeletonization of the stifles, the length and cross-sectional area of the intact CCL and CCL substitutes were determined. Each bone-ligament unit was tested in linear tension to failure at a fixed distraction rate of 15 mm/s with the stifle in 120° flexion. Data was processed to obtain the corresponding material parameters (modulus, stress and strain in the linear loading region, and energy absorption to maximum load).The immediate postoperative structural and material properties of the “under-and-over” cranial cruciate ligament replacement technique with autogenous fascia lata, were compared to that of a modified intra- and extracapsular “under-and-over-the-top” (UOTT) method. The combined UOT T technique was slightly stronger (6%), but allowed 2.8 ± 0.9 mm more cranial tibial displacement at maximum linear force.

Download Full-text