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.

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 A Prospective Comparative Study Correlating the Efficacy of Biodegradable versus Metallic Interference Screw for Tibial Sided Anterior Cruciate Ligament Reconstruction - A Unicentre Pilot Study in Jaipur, Rajasthan

2021 ◽  
Vol 8 (18) ◽  
pp. 1258-1263
Author(s):  
Vishal Singh ◽  
Alokeshwar Sharma ◽  
Avinash Gundavarapu ◽  
Tejas Patel ◽  
Santosh Kumar M
Keyword(s):  
Anterior Cruciate Ligament ◽  
Comparative Study ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Single Bundle ◽  
Interference Screws ◽  
Prospective Comparative Study ◽  
Anterior Cruciate ◽  
Screw Group

BACKGROUND Traditionally, metallic interference screws were considered to have increased resistance to load than bio absorbable screws in anterior cruciate ligament (ACL) reconstruction. We did a comparative evaluation of biodegradable and metallic interference screws for tibial sided ACL reconstruction and also analysed complications, compared clinical outcome, did imaging study of ACL single bundle reconstruction by using titanium & newer poly–L-lactic acid (PLLA) bio absorbable screws to determine as to whether bio absorbable screw which costs double the metallic screw, is functionally better than standard metallic screws. METHODS This is a prospective comparative study conducted among 50 patients aged between 15 and 55 years with clinical and MRI confirmation of complete ACL tear, treated arthroscopically with ACL reconstruction with either bio absorbable (group 1) or metallic (group 2) interference screw and both the groups were compared on follow up for an average duration of 12 months. Lysholm and Gillquist Knee Scoring Scale were used and outcome scores were divided into excellent, good, fair and poor. RESULTS In our study 41 patients were males and 9 were females. Bio screw was used in 24 males and 6 female patients. Metallic screw was used in 17 males and 3 females. Outcome score was excellent in 26 (52 %) cases, good in 18 (36 %) cases, fair in 4 (8 %) cases, poor in 2 (4 %) cases. The mean Lysholm score in bio absorbable group was 93.13 and in metallic group was 89.70. Knee effusion was higher in bio screw group and infection rate was higher in metallic group. CONCLUSIONS In our study, the difference between bio absorbable screw group and metallic screw group was insignificant with regard to final patient outcome. Final osseointegration was better with bio absorbable screw, but increased cost of implant and almost same results compared to metallic screw does not make the bio absorbable screw superior to its counterpart. KEYWORDS ACL, Bio Absorbable Interference Screws, Metallic Interference Screws

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

POSTEROMEDIAL MENISCAL AND ANTERIOR CRUCIATE LIGAMENT STRAINS DURING DYNAMIC ACTIVITIES FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

2020 ◽  
Vol 23 (02) ◽  
pp. 2050010
Author(s):  
Sebastian Tomescu ◽  
Ryan Bakker ◽  
David Wasserstein ◽  
Mayank Kalra ◽  
Micah Nicholls ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Strain Difference ◽  
Cruciate Ligament ◽  
Knee Simulator ◽  
Lower Strain ◽  
Healthy Knee ◽  
Anterior Cruciate ◽  
The Impact

Background: Meniscal strain patterns are not well understood during dynamic activities. Furthermore, the impact of ACL reconstruction on meniscal strain has not been thoroughly investigated. The purpose of this study was to characterize ACL and meniscal strain during dynamic activities and investigate the strain difference between ACL-intact and ACL-reconstructed ligament conditions. Methods: ACL and medial meniscal strain were measured in-vitro during gait, a double leg squat, and a single leg squat. For each activity kinematics and muscle forces were applied to seven cadaveric specimens using a dynamic knee simulator. Testing was performed in the ACL-intact and ACL-reconstructed ligament conditions. Results: Both the ACL and meniscus had distinct strain patterns that were found to have a significant interaction with knee angle during gait and double leg squat ([Formula: see text]). During gait, both tissues experienced lower strain during swing than stance (ACL: 3.0% swing, 9.1% stance; meniscus: 0.2% swing, 1.3% stance). Meniscal strain was not found to be different between ACL-intact and ACL-reconstructed conditions ([Formula: see text]). Conclusions: During dynamic activities, the strain in the meniscus was not altered between ACL ligament conditions. This indicates that meniscal mechanics after ACL reconstruction are similar to a healthy knee. These results help further the understanding of osteoarthritis risk after ACL reconstruction.

Fibroblasts From Common Anterior Cruciate Ligament Tendon Grafts Exhibit Different Biologic Responses to Mechanical Strain

2020 ◽  
Vol 49 (1) ◽  
pp. 215-225
Author(s):  
Sebastian Cardona-Ramirez ◽  
Aaron M. Stoker ◽  
James L. Cook ◽  
Richard Ma
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Metabolic Activity ◽  
Cruciate Ligament ◽  
Mechanical Strain ◽  
Advantages And Disadvantages ◽  
Relative Paucity ◽  
Tendon Grafts ◽  
Anterior Cruciate

Background: Different tendons are chosen for anterior cruciate ligament (ACL) reconstruction based on perceived advantages and disadvantages, yet there is a relative paucity of information regarding biologic responsiveness of commonly used tendon grafts to mechanical strain. Purpose: To evaluate the in vitro responses of graft fibroblasts derived from tendons used for ACL reconstruction to clinically relevant strain levels. Study Design: Controlled laboratory study. Methods: Twelve quadriceps tendons (QTs), 12 patellar tendons (PTs), and 9 hamstring tendons (HTs) were harvested from skeletally mature dogs (n = 16). Tendon fibroblasts were isolated and seeded onto BioFlex plates (1 × 105 cells/well). Cells were subjected to 3 strain conditions (stress deprivation, 0%; physiologic, 4%; high, 10%) for 5 days. Media were collected for proinflammatory and metabolic assays. RNA was extracted for gene expression analysis using real-time reverse transcription polymerase chain reaction. Results: Stress deprivation elicited significantly higher metabolic activity from HT and PT cells than from QT cells ( P < .001 and P = .001, respectively). There were no differences in metabolic activity among all 3 graft fibroblasts at physiologic and high strain. COL-1 expression was significantly higher in PT versus HT during physiologic strain ( P = .007). No significant differences with COL-3 expression were seen. TIMP-1 ( P = .01) expression was higher in PT versus HT under physiologic strain. Scleraxis expression was higher in PT versus HT ( P = .007) under physiologic strain. A strain-dependent increase in PGE2 levels occurred for all grafts. At physiologic strain conditions, HT produced significantly higher levels of PGE2 versus QT ( P < .001) and PT ( P = .005). Conclusion: Fibroblasts from common ACL graft tissues exhibited different metabolic responses to mechanical strain. On the basis of these data, we conclude that early production of extracellular matrix and proinflammatory responses from ACL grafts are dependent on mechanical loading and graft source. Clinical Relevance: Graft-specific differences in ACL reconstruction outcomes are known to exist. Our results suggest that there are differences in the biologic responsiveness of cells from the tendon grafts used in ACL reconstruction, which are dependent on strain levels and graft source. The biologic properties of the tissue used for ACL reconstruction should be considered when selecting graft source.

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 An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging

2021 ◽  
pp. 036354652110171
Author(s):  
Lukas Willinger ◽  
Kiron K. Athwal ◽  
Andy Williams ◽  
Andrew A. Amis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Bone Bruise ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Acl Transection

Background: Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma. Purpose: To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction. Study Design: Controlled laboratory study. Methods: Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm/min to rupture the ACL at 22.5° of flexion, 5° of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone–patellar tendon–bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0° to 100° of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus). Results: The ACL ruptured at 26 ± 5 mm of ATT and 1550 ± 620 N of force (mean ± SD) with an audible spring-back tibiofemoral impact with 5o of valgus. ACL injury and transection increased ATT ( P < .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0° and 30° of flexion and in ACL transection knees from 0° to 20° of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0° and 80° and after ACL transection between 0° and 60°. Residual laxity persisted after ACL reconstruction from 0° to 40° after ACL injury and from 0° to 20° in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test ( P < .001). The ATT in the pivot-shift increased significantly at 0° to 20° after ACL transection and 0° to 50° after ACL injury, and this persisted across 0° to 20° and 0° to 40° after ACL reconstruction. Conclusion: This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction. Clinical Relevance: This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.

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