Significant Loss of ACL Graft Force With Tibial-Sided Soft Tissue Interference Screw Fixation Over 24 Hours: A Biomechanical Study.
ACL
biomechanical testing
hamstring graft
interference screw
tibial fixation
Journal
Orthopaedic journal of sports medicine
ISSN: 2325-9671
Titre abrégé: Orthop J Sports Med
Pays: United States
ID NLM: 101620522
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
entrez:
23
5
2020
pubmed:
23
5
2020
medline:
23
5
2020
Statut:
epublish
Résumé
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. 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. Controlled laboratory study. 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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
OBJECTIVE
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
METHODS
Controlled laboratory study.
METHODS
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
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
CONCLUSIONS
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
CONCLUSIONS
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.
Identifiants
pubmed: 32440520
doi: 10.1177/2325967120916437
pii: 10.1177_2325967120916437
pmc: PMC7225828
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2325967120916437Informations de copyright
© The Author(s) 2020.
Déclaration de conflit d'intérêts
One or more of the authors has declared the following potential conflict of interest or source of funding: The screws used in this study were provided by the Richard Wolf GmbH. S.K. has received speaking fees from Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Références
Arch Orthop Trauma Surg. 2013 Sep;133(9):1309-14
pubmed: 23836318
Arthroscopy. 2010 Aug;26(8):1105-10
pubmed: 20678709
Am J Sports Med. 2001 Sep-Oct;29(5):614-9
pubmed: 11573920
Cochrane Database Syst Rev. 2016 Jul 24;7:CD009772
pubmed: 27450741
Arch Orthop Trauma Surg. 2016 Oct;136(10):1465-71
pubmed: 27475640
Am J Sports Med. 2004 Apr-May;32(3):765-71
pubmed: 15090395
Arthroscopy. 2011 May;27(5):637-43
pubmed: 21429700
Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2353-8
pubmed: 25429763
Bull Hosp Jt Dis. 2006;63(3-4):153-5
pubmed: 16878837
Am J Sports Med. 2009 Feb;37(2):334-8
pubmed: 19118082
Eur Cell Mater. 2007 Mar 02;13:1-10
pubmed: 17334975
Arthroscopy. 1993;9(4):417-24
pubmed: 8216573
Int Orthop. 2014 Dec;38(12):2499-503
pubmed: 25123129
Am J Sports Med. 1994 May-Jun;22(3):334-8
pubmed: 8037273
Orthopedics. 2005 Aug;28(8):779-83
pubmed: 16119743
Am J Sports Med. 1987 May-Jun;15(3):225-9
pubmed: 3303979
Knee Surg Sports Traumatol Arthrosc. 2013 Mar;21(3):584-8
pubmed: 22434161
Am J Sports Med. 1999 Jan-Feb;27(1):35-43
pubmed: 9934416
Am J Sports Med. 2004 Mar;32(2):411-7
pubmed: 14977666
Knee Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):2884-2891
pubmed: 25715849
BMC Musculoskelet Disord. 2010 Jun 30;11:139
pubmed: 20591177
Knee. 2006 Dec;13(6):455-9
pubmed: 17046263
Arthroscopy. 2005 Oct;21(10):1202
pubmed: 16226648
J Biomech. 2006;39(6):1153-7
pubmed: 16549103
J Biomech. 1986;19(5):399-404
pubmed: 3733765
Arthroscopy. 2013 Nov;29(11):1804-10
pubmed: 24011556
Arthroscopy. 2009 Feb;25(2):200-7
pubmed: 19171281
Knee. 2010 Jun;17(3):245-8
pubmed: 19744857
Arch Orthop Trauma Surg. 2016 May;136(5):681-6
pubmed: 26899033
Arthroscopy. 2002 Mar;18(3):304-15
pubmed: 11877619
Knee Surg Sports Traumatol Arthrosc. 2004 Sep;12(5):486-9
pubmed: 14767640
Strategies Trauma Limb Reconstr. 2007 Apr;2(1):1-12
pubmed: 18427909
Am J Sports Med. 2010 Aug;38(8):1598-605
pubmed: 20392970
J Orthop Res. 2000 May;18(3):456-61
pubmed: 10937634
Am J Sports Med. 1993 Nov-Dec;21(6):880-6
pubmed: 8291644
J Bone Joint Surg Am. 2006 May;88(5):1071-8
pubmed: 16651582
Knee Surg Sports Traumatol Arthrosc. 2011 Mar;19(3):347-54
pubmed: 20680245
Clin Orthop Surg. 2014 Jun;6(2):173-9
pubmed: 24900898
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015 Oct 14;2(4):122-128
pubmed: 29264251
Am J Sports Med. 2004 Jun;32(4):881-91
pubmed: 15150033
Am J Sports Med. 2000 Sep-Oct;28(5):761-74
pubmed: 11032238
Endocrinology. 1998 Feb;139(2):663-70
pubmed: 9449639
Am J Sports Med. 2010 Mar;38(3):501-8
pubmed: 20044497
Knee Surg Sports Traumatol Arthrosc. 1998;6 Suppl 1:S2-12
pubmed: 9608456
Joints. 2018 Sep 27;6(3):177-187
pubmed: 30582107
J Orthop Res. 1984;1(4):405-11
pubmed: 6387075
Am J Sports Med. 1999 Nov-Dec;27(6):778-83
pubmed: 10569365
J Orthop Res. 2008 Nov;26(11):1506-11
pubmed: 18473384
Am J Sports Med. 2004 Mar;32(2):418-24
pubmed: 14977667
Am J Sports Med. 2007 Mar;35(3):384-94
pubmed: 17218661
PLoS One. 2016 Jul 28;11(7):e0159600
pubmed: 27467744
Musculoskelet Surg. 2011 Dec;95(3):183-91
pubmed: 21538096
Arthroscopy. 1995 Oct;11(5):596-9
pubmed: 8534303
Arthroscopy. 2003 Nov;19(9):991-6
pubmed: 14608319
Vet Pathol. 2015 Sep;52(5):842-50
pubmed: 26163303
Am J Sports Med. 2000 Nov-Dec;28(6):846-9
pubmed: 11101107
Knee. 2003 Mar;10(1):97-102
pubmed: 12649035
Am J Sports Med. 1997 Jan-Feb;25(1):99-106
pubmed: 9006702
Ann Biomed Eng. 1998 May-Jun;26(3):345-52
pubmed: 9570217
Arthroscopy. 2002 Oct;18(8):901-7
pubmed: 12368789
Knee Surg Sports Traumatol Arthrosc. 2007 Sep;15(9):1066-71
pubmed: 17497130
Arthroscopy. 1995 Jun;11(3):275-88
pubmed: 7632302
Arthroscopy. 2013 May;29(5):934-41
pubmed: 23566570
Am J Sports Med. 2000 May-Jun;28(3):356-9
pubmed: 10843127
J Orthop Sci. 2000;5(6):585-92
pubmed: 11180923