Investigation of a hybrid method of soft tissue graft fixation for anterior cruciate ligament reconstruction

Abstract 

To increase knee stability following anterior cruciate ligament (ACL) reconstruction, development of increasingly stronger and stiffer fixation is required. This study assessed the initial pullout force, stiffness of fixation, and failure modes for a novel hybrid fixation method combining periosteal and direct fixation using porcine femoral bone. A soft tissue graft was secured by combining both an interference screw and an EndoButton (Smith and Nephew Endoscopy, Andover, MA). The results were compared with the traditional direct fixation method using a titanium interference screw. Twenty porcine hindlimbs were divided into two groups. Specimens were loaded in line with the bone tunnel on a materials testing machine. Maximum pullout force of the hybrid fixation (588±37 N) was significantly greater than with an interference screw alone (516±37 N). The stiffness of the hybrid fixation (52.1±12.8 N/mm) was similar to that of screw fixation (56.5±10.2 N/mm). Graft pullout was predominant for screw fixation, whereas a combination of graft pullout and graft failure was seen for hybrid fixation. These results indicate that initial pullout force of soft tissue grafts can be increased by using the suggested novel hybrid fixation method.

Keywords: Anterior cruciate ligament, EndoButton, Soft tissue graft, Interference screw, Fixation