scholarly journals ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION NUMERIC AND EXPERIMENTAL ANALYSES: INFLUENCE OF TRABECULAR BONE CONSTITUTIVE MODEL

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
C Quintana Barcia ◽  
C Rodríguez González ◽  
C Betegón Biempica ◽  
G Álvarez Díaz ◽  
A Maestro
Keyword(s):  
Finite Element ◽  
Constitutive Model ◽  
Trabecular Bone ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Computational Cost ◽  
Interference Screw ◽  
Compression Tests ◽  
Confined Compression ◽  
Von Mises

Abstract INTRODUCTION The number of variables that influence the success of an ACL reconstruction is such that, the use of numerical tools becomes increasingly necessary. In this work, a finite element model is developed to simulate the ACL reconstruction in its tibial insertion. MATERIAL AND METHODS Tibiae and ligaments porcine samples were used in this work. As the tibial fixation, an interference screw with a nominal diameter of 7mm and a length of 25mm is used. The plasty which replace the injured ligament was characterize using tensile tests. Uniaxial and confined compression tests, as well as indentation tests, were used for characterizing trabecular bone. Finite element methods were used for the implementation of the ACL reconstruction simulation, which studies the effect in the knee joint of all the elements involved (plasty, bone and interference screw). RESULTS None of the models available for the description of the trabecular bone behavior (von Mises, Hill and Crushable Foam), is capable of doing it in a completely proper manner. The use of one or the other constitutive model does not greatly influence the numerical simulation results. CONCLUSIONS As trabecular bone has a strongly anisotropic and non-symmetric mechanical behavior, none of the constitutive models available in the finite element code used is capable of fully describing it. Thus, the use of von Mises criterion is recommended, as it is the easiest to define and the one that requires the least numerical resources (lower computational cost).

Stacked Biocomposite Screws in a Single-Stage Revision Anterior Cruciate Ligament Reconstruction Has Acceptable Fixation Strength in a Porcine Cadaveric Model

2021 ◽  
pp. 036354652110151
Author(s):  
Hasan Baydoun ◽  
Ian D. Engler ◽  
Ali Hosseini ◽  
Lance LeClere ◽  
Joeri Zoon ◽  
...  
Keyword(s):  
Bone Loss ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Single Stage ◽  
Fixation Strength ◽  
Revision Acl Reconstruction ◽  
Group 2 ◽  
Bone Tunnels ◽  
Primary Acl Reconstruction

Background: Stacked screws is a commonly used technique in single-stage revision anterior cruciate ligament (ACL) reconstruction in the setting of bone loss, but there are limited data to support its use. Hypothesis: Two configurations of a biocomposite stacked screws construct have similar fixation strength and linear stiffness as a primary ACL reconstruction construct in a biomechanical model. Study Design: Controlled laboratory study. Methods: A total of 30 porcine legs were divided into 3 groups. Group 1 underwent primary ACL reconstruction with a patellar tendon graft fixed into the femur, with an 8-mm biocomposite interference screw of beta-tricalcium phosphate and poly lactide-co-glycolide. For a revision ACL reconstruction model, groups 2 and 3 had bone tunnels created and subsequently filled with 12-mm biocomposite screws. New bone tunnels were drilled through the filler screw and the surrounding bone, and the patellar bone plug was inserted. Group 2 was fixed with 8-mm biocomposite screws on the side of the graft opposite the filler screw, while group 3 had the interference screw interposed between the graft and the filler screw. The construct was loaded at 1.5 mm/s in line with the tunnel until failure. Load to failure, linear stiffness, and mode of failure were recorded. Results: The mean pullout strength for groups 1, 2, and 3 was 626 ± 145 N, 653 ± 152 N, and 720 ± 125 N, respectively ( P = .328). The mean linear stiffness of the construct in groups 1, 2, and 3 was 71.4 ± 9.9 N/mm, 84.1 ± 11.1 N/mm, and 82.0 ± 10.8 N/mm, respectively. Group 2 was significantly stiffer than group 1 ( P = .037). Conclusion: Two configurations of a biocomposite stacked screws construct for a single-stage revision ACL reconstruction in the setting of bone loss show a similar fixation strength and linear stiffness to a primary ACL reconstruction at time zero in a porcine model. Clinical Relevance: In the setting of bone loss from tunnel malpositioning, a single-stage revision ACL reconstruction using a stacked screws construct may provide adequate fixation strength and linear stiffness.

scholarly journals Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction? A biomechanical study in vitro

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yuanjun Teng ◽  
Xiaohui Zhang ◽  
Lijun Da ◽  
Jie Hu ◽  
Hong Wang ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Interference Screws ◽  
Suture Group ◽  
Anterior Cruciate ◽  
Biomechanical Tests ◽  
Single Insertion

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.

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

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.

Miniplate Suture Button Augmentation for Soft Tissue Graft Tibial Fixation in Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 104 (2) ◽  
pp. 277-285
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Tibial Fixation ◽  
Suture Button ◽  
Soft Tissue Graft ◽  
Anterior Cruciate ◽  
Supplemental Fixation

Background: Anterior cruciate ligament (ACL) reconstruction requires reliable and rigid graft fixation. Tibial-sided fixation is frequently cited as the “weak point” of the femur-graft-tibia construct. Some authors have recommended supplemental fixation with a staple or screw suture to post improve the strength and stiffness of the fixation. However, with these fixations, there is a risk for symptomatic hardware. Miniplate is flatter than screw or staple and does not penetrate the bone when attached. It is used as a button for suspensory fixation to enhance interference screw tibial fixation. Objective: To evaluate the clinical outcomes of the miniplate suture button for supplemental soft tissue graft tibial fixation in ACL reconstruction. Materials and Methods: A retrospective study was carried out between August 2016 and December 2019. A total of 40 patients had undergone primary ACL reconstruction, performed with hamstring tendon grafts that were secured using a miniplate suture button for supplemental interference screw tibial fixation. A total of 18 patients were excluded, leaving 22 patients at 1-year follow-up. Results: At least 1-year follow-up, the remaining 22 patients had significant difference between preoperative and postoperative outcome of anterior drawer test, Lachman test and pivot shift test (p<0.05). Lysholm knee scores improved significantly from 54.0±12.53 to 90.04±5.38. However, 3 patients (13.6%) experienced symptomatic hardware pain and 3 patients (13.6%) tendered around the miniplate site. There were no radiographic changes in miniplate displacement, deformed or broken plate, and bony reaction around miniplate. Conclusion: The use of a miniplate suture button as a supplemental fixation showed adequate fixation strength and showed good results in postoperative manual ligament laxity test and functional scores at minimum 1-year follow-up. However, there is still symptomatic pain at the hardware site. Keywords: Anterior cruciate ligament reconstruction, Supplemental fixation, Suture button

scholarly journals Design of a new magnesium-based anterior cruciate ligament interference screw using finite element analysis

2020 ◽  
Vol 20 ◽  
pp. 25-30
Author(s):  
Jonquil R. Mau ◽  
Kevin M. Hawkins ◽  
Savio L.-Y. Woo ◽  
Kwang E. Kim ◽  
Matthew B.A. McCullough
Keyword(s):  
Finite Element Analysis ◽  
Finite Element ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Element Analysis ◽  
Anterior Cruciate

scholarly journals TECHNICAL VARIATION IN AFFIXING HAMSTRING GRAFTS TO THE TIBIA IN ACL RECONSTRUCTION

2018 ◽  
Vol 26 (2) ◽  
pp. 94-97
Author(s):  
MARCUS VINICIUS DANIELI ◽  
JOÃO PAULO FERNANDES GUERREIRO ◽  
ALEXANDRE OLIVEIRA QUEIROZ ◽  
CARLOS ROBERTO PADOVANI
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Case Series ◽  
International Knee Documentation Committee ◽  
Interference Screw ◽  
Anatomic Reconstruction ◽  
Anatomic Acl Reconstruction ◽  
Level Of Evidence ◽  
Hamstring Grafts

ABSTRACT Purpose: To present a technical variation in tibial fixation of quadruple hamstring grafts during anatomic reconstruction of the anterior cruciate ligament (ACL). The secondary purpose was to decrease the costs associated with this procedure. Methods: Twenty patients who underwent ACL reconstruction were selected. A tibial tunnel was constructed using standard techniques, and a femoral tunnel was anatomically created using the outside-in technique. The hamstring autograft was passed (with its bend) into the tibial tunnel and affixed to the tibia using the suspensory technique and a simple staple. Femoral fixation was performed using a titanium interference screw. The patients underwent postoperative evaluations at 0, 3, 6 and 12 months using the subjective International Knee Documentation Committee (IKDC) form and Lysholm knee scores. Results: The IKDC and Lysholm score results improved over time (p<0.001) without major complications. The cost of the procedure could be reduced by using lower-cost hardware (staples). Conclusion: The proposed technique for anatomic ACL reconstruction using inverted hamstring grafts with their bend in the tibial tunnel, suspension-type fixation using a staple demonstrated good to excellent results after 1 year of follow up, with lower aggregate costs. Level of Evidence IV; Case series.

scholarly journals In Vitro Testing of 2 Adjustable-Loop Cortical Suspensory Fixation Systems Versus Interference Screw for Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110316
Author(s):  
Gerardo L. Garcés ◽  
Oscar Martel ◽  
Alejandro Yánez ◽  
Ignacio Manchado-Herrera ◽  
Luci M. Motta
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Failure Load ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Yield Load ◽  
Ultimate Failure Load ◽  
Significant Difference ◽  
Ultimate Failure ◽  
Anterior Cruciate

Background: It is not clear whether the mechanical strength of adjustable-loop suspension devices (ALDs) in anterior cruciate ligament (ACL) reconstruction is device dependent and if these constructs are different from those of an interference screw. Purpose: To compare the biomechanical differences of 2 types of ALDs versus an interference screw. Study Design: Controlled laboratory study. Methods: ACL reconstruction was performed on porcine femurs and bovine extensor tendons with 3 types of fixation devices: interference screw, UltraButton (UB) ALD, and TightRope (TR) ALD (n = 10 for each). In addition to specimen testing, isolated testing of the 2 ALDs was performed. The loading protocol consisted of 3 stages: preload (static 150 N load for 5 minutes), cyclic load (50-250 N at 1 Hz for 1000 cycles), and load to failure (crosshead speed 50 mm/min). Displacement at different cycles, ultimate failure load, yield load, stiffness, and failure mode were recorded. Results: In specimen testing, displacement of the ALDs at the 1000th cycle was similar (3.42 ± 1.34 mm for TR and 3.39 ± 0.92 mm for UB), but both were significantly lower than that of the interference screw (7.54 ± 3.18 mm) ( P < .001 for both). The yield load of the UB (547 ± 173 N) was higher than that of the TR (420 ± 72 N) ( P = .033) or the interference screw (386 ± 51 N; P = .013), with no significant difference between the latter 2. In isolated device testing, the ultimate failure load of the TR (862 ± 64 N) was significantly lower than that of the UB (1879 ± 126 N) ( P < .001). Conclusion: Both ALDs showed significantly less displacement in cyclic loading at ultimate failure than the interference screw. The yield load of the UB was significantly higher than that of the other 2. The ultimate failure occurred at a significantly higher load for UB than it did for TR in isolated device testing. Clinical Relevance: Both UB and TR provided stronger fixation than an interference screw. Although difficult to assess, intrinsic differences in the mechanical properties of these ALDs may affect clinical outcomes.

scholarly journals Significant Loss of ACL Graft Force With Tibial-Sided Soft Tissue Interference Screw Fixation Over 24 Hours: A Biomechanical Study

2020 ◽  
Vol 8 (5) ◽  
pp. 232596712091643
Author(s):  
Philipp Kruppa ◽  
Anne Flies ◽  
Dag Wulsten ◽  
Robert Collette ◽  
Georg N. Duda ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Fixation Strength ◽  
Screw Length ◽  
Screw Diameter ◽  
Tissue Grafts ◽  
Soft Tissue Grafts

Background: Tibial-sided graft fixation is thought to be critical for the success of anterior cruciate ligament (ACL) reconstruction. Nevertheless, little is known about the graft force after fixation during the first 24 hours after surgery or the influence of screw diameter and length during this time. Purpose: To investigate the force, over the course of 24 hours, in soft tissue grafts secured with a tibial interference screw and to evaluate the effect of different screw diameters (7, 8, and 9 mm) and lengths (25 and 30 mm) on the force in these grafts. Study Design: Controlled laboratory study. Methods: Quadruple-strand flexor tendon grafts were fixed with bioabsorbable interference screws in 60 porcine tibiae. Grafts were pretensioned at 80 N over 10 minutes, and screws were inserted outside-in while a preload force of 80 N was applied. Different screw lengths (25 and 30 mm) and diameters (7, 8, and 9 mm), resulting in 6 groups with 10 specimens each, were tested. After release of the preload, graft force was recorded over 24 hours. Results: A significant decrease in graft force progressed in all groups over the 24-hour period. In total, a median loss of 75 N (IQR, 68-79 N) compared with the initial loading force was observed. Compared with the loading force of 80 N, this corresponded to a median loss of 91%. No significant differences in the remaining graft force could be found among the 6 different screw length and diameter groups after 10 minutes, 100 minutes, or 24 hours. Conclusion: Graft force in soft tissue grafts secured with a tibial interference screw decreased substantially over the first 24 hours after fixation. Neither the screw diameter nor the screw length affected the decrease in graft force. This raises substantial questions regarding the remaining fixation strength in vivo. Clinical Relevance: It should not be expected that ACL reconstruction can mechanically restabilize an injured knee as would an intact ACL. Reconstructed knees should be protected from mechanical overload in the early postoperative period.

scholarly journals Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

2021 ◽  
Author(s):  
Yang Xiao ◽  
Ming Ling ◽  
Zhenming Liang ◽  
Jian Ding ◽  
Shi Zhan ◽  
...  
Keyword(s):  
Finite Element ◽  
Acl Reconstruction ◽  
Imaging Techniques ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Single Bundle ◽  
Full Extension ◽  
Graft Placement ◽  
Fluoroscopic Imaging

Abstract Purpose Little is known about the in vivo forces and stresses on grafts used in anterior cruciate ligament (ACL) reconstruction. The aims of this study were to evaluate and compare the forces and stresses on grafts used in anatomical single-bundle ACL reconstruction at different locations of the femoral footprint (anterior vs middle vs posterior; high vs middle vs low) during a lunge motion. Methods Establish subject-specific finite element models with different graft’s tunnel loci to represent the primary ACL reconstructions. A displacement controlled finite element method was used to simulate lunge motions (full extension to ~ 100° of flexion) with six-degree-of-freedom knee kinematics data obtained from the validated dual fluoroscopic imaging techniques. The reaction force of the femur and maximal principal stresses of the grafts were subsequently calculated during knee flexion. Results Increased and decreased graft forces were observed when the grafts were located higher and lower on the femoral footprint, respectively; anterior and posterior graft placement did not significantly affect the graft force. Lower and posterior graft placement resulted in less stress on the graft at higher degrees of flexion; there were no significant differences in stress when the grafts were placed from 0° to 30° of flexion on the femoral footprint. Conclusion The proposed method is able to simulate knee joint motion based on in vivo kinematics. The results demonstrate that posterior to the centre of the femoral footprint is the strategic location for graft placement, and this placement results in anatomical graft behaviour with a low stress state.

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