Interference screws should be shorter than the hamstring tendon graft in the bone tunnel for best fixation

Purpose: Interference screw fixation of hamstring tendon grafts in bone has to overcome the challenges that tendons have a slippery surface and viscoelastically adapt under pressure. As the typical failure mode of the graft is to slip past the interference screw, it was hypothesized that the position and configuration of the graft end may be of influence on the fixation strength. Methods: Different configurations of the graft ending and its effect to primary fixation with interference screws after viscoelastic adaptation were tested in six groups: I: graft and the screw inserted at the same depth, II/III: the graft overlaps the tip of the screw (interference screw of 28 and 19mm in length, respectively), IV: strengthening of the graft ending with additional suture knots, V: Endopearl, respectively, and VI: effect of partial retraction of the screw after excessive insertion. In vitro tests were performed with fresh calf tendon grafts and interference screws in bone tunnels (fresh porcine distal femur) all of 8mm in diameter. Results: The relative position of the graft ending to the tip of the interference screw thereby was recognized as a significant factor on pullout forces. Further strengthening at the graft endings with additional suture knots or an Endopearl device could improve primary hold as well. Conclusions: Better fixation strength is achieved if the tip of interference screw does not extend past the end of a tendon graft. Enforcement of the tendon end with sutures or an implant can further improve fixatio

Comparison of mechanical properties in interference screw fixation technique and organic anterior cruciate ligament reconstruction method: a biomechanical study

© 2021 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background Bone and Site Hold Tendon Inside (BASHTI) technique is an organic implant-less technique for anterior cruciate ligament (ACL) reconstruction with some clinical advantages, such as speeding up the healing process, over implantable techniques. The study aims to compare the mechanical properties of BASHTI technique with the conventional interference screw technique. Methods To investigate the mechanical properties, 20 in-vitro experimental tests were conducted. Synthetic dummy bone, along with fresh digital bovine tendons, as a graft, were used for experiments. Three loading steps were applied to all specimens, including a preconditioning, a main cyclic, and a pull-out loading. Results The mechanical characters of an interference screw technique using an 8 mm tendon diameter, including fixation strength, average cyclic stiffness (ACS), and average pull-out stiffness (APS) were found to be 439 ± 132 N, 10.3 ± 5.3 kN/mm, and 109 ± 40 N/mm, respectively. In the case of an interference screw using a 9 mm tendon, the fixation strength, ACS, and APS were obtained 549 ± 87 N, 10.3 ± 4.7 kN/mm, and 91 ± 13 N/mm, respectively. In parallel, the fixation strength, APS, and ACS of BASHTI technique using an 8 mm tendon were 360 ± 123 N, 3.3 ± 0.6 kN/mm, and 79 ± 27 N/mm, respectively, while, for 9 mm tendon 278 ± 103 N, 2.4 ± 1.2 kN/mm, and 111 ± 40 N/mm, were reported for fixation strength, APS, and ACS respectively when BASHTI technique was used. Conclusion About 50% of interference screw samples showed superior mechanical properties compared to BASHTI technique, but in another half of the samples, the differences were not significant (N.S.). However, due to organic advantages of BASHTI technique and lower cost, it could be used as a substitute for interference screw technique, especially where fast recovery is expected.Peer reviewe

Distal Biceps Tendon Ruptures: A Comparison of Surgical Techniques and Outcomes

The rupture of a distal biceps tendon is a traumatic acute injury, that is also relatively rare. Because of this rarity, there remains a significant amount of controversy over which method of fixation is the preferred option. In addition to the controversy over which surgical method to use, it has been recently discovered that the distal biceps tendon actually consists of two tendons, which contribute individually to the movements of the forearm. The current most common methods of fixation include: interosseous tunnel, interference screw, cortical button, and cortical button with an interference screw. Although all of the options available serve as appropriate methods of fixation for the ruptured distal bicep tendon, the use of the cortical button with the interference screw has shown to be significantly stronger than the other options, while also allowing a more anatomical repair. Because of this, the cortical button with an interference screw fixation method may be able to become the standard protocol to repair the ruptured distal biceps tendon. After the surgery postoperative protocol consists of elbow immobilization for up to three weeks, followed by a rehabilitation with a focus on achieving full range of motion and normal strength and stabilization of the arm. Currently the surgical repair of ruptured distal biceps tendons is a standard practice with 97% of all patients returning to full pre-injury activity.14 With the continuing improvement in surgical procedures, one day there may be one standard surgical option available that has few complications, is minimally invasive, and has an extremely high success rate

An observational retrospective study on safety and functional outcomes of arthroscopic anterior cruciate ligament reconstruction using Sironix suture button and interference screw

Background: Anterior cruciate ligament (ACL) injury is a persistent orthopaedic condition that affects a wide spectrum of people. ACL reconstruction (ACL-R) stands out as the primary treatment option. Graft fixation with suture buttons and interference screws has proven to be a highly successful and reliable method for ACL-R. In this context, our research aims to assess the safety and functional outcomes of patients who underwent arthroscopic ACL-R using the Sironix suture button and interference screw. Methods: This was a retrospective observational study. Patients who underwent arthroscopic ACL-R using Sironix suture button and interference screw (January 2018-March 2022) were included in the study. Functional outcomes of patients were evaluated using the international knee documentation committee (IKDC) assessment, the Tegner activity scale (TAS), the Lysholm knee scoring scale, the modified knee injury and osteoarthritis outcome score (KOOS) quality of life subscale, and the single assessment numerical evaluation (SANE) score. Adverse events, if any, were recorded. Results: All patients achieved excellent outcome measures for IKDC, Tegner, Lysholm, KOOS, and SANE scores. The mean (SD) IKDC score was 88.76 (7.16), Tegner activity score was 5.9 (1.13), while the Lysholm score was 96.9 (6.56). The overall KOOS score was 93.7 (7.52), and the overall SANE score for the affected joint was 94.5 (7.22). Conclusions: Arthroscopic ACL-R using Sironix implants (Helysis titanium interference screw, Helysis PLDLA+β-TCP interference screw, Infiloop fixed loop UHMWPE suture titanium button, Proloop adjustable loop UHMWPE suture Titanium button, and Titanium suture disc) demonstrated safety and good functional outcomes

Surgical technique for arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor.

The long head of the biceps is a frequent pain generator in the shoulder. Tendinopathy of the long head of the biceps may be treated with biceps tenodesis. There has been great debate about the optimal technique for biceps tenodesis, without a clear distinction between different techniques. Biceps tenodesis fixation may include interference fixation, suspensory fixation, all-suture anchors, and soft tissue fixation. In this technical note, we describe an all-arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor

Mechanical evaluation of tibial fixation of the hamstring tendon in anterior cruciate ligament double-bundle reconstruction with and without interference screws

OBJECTIVE: The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS: A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2 ) were objectively determined in each group. RESULTS: Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2 ; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2 ; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION: The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws

A randomized controlled trial of PEEK versus titanium interference screws for anterior cruciate ligament reconstruction with 2-year follow-up

Purpose: To compare the clinical performance of ACL reconstruction with PEEK and titanium interference screws at 2 years and to evaluate a novel method of measuring tunnel volume. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 133 patients underwent arthroscopic ACL reconstruction with 4-strand hamstring autografts and were randomized to have titanium or PEEK interference screws for femoral and tibial tunnel fixation. At 2 years, subjective Lysholm and International Knee Documentation Committee scores were assessed and clinical examination performed. At 12 months, MRI was performed to assess graft incorporation and cyst formation, and a novel technique was employed to measure tunnel volumes. Results: There were no significant differences in graft rerupture rate, contralateral ACL rupture rate, subjective outcomes, or objective outcomes. In the titanium and PEEK groups, MRI demonstrated high overall rates of graft integration (96%-100% and 90%-93%, respectively) and ligamentization (89% and 84%) and low rates of synovitis (22% and 10%) and cyst formation (0%-18% and 13%-15%). There was a higher proportion of patients with incomplete graft integration within the femoral tunnel in the PEEK group as compared with the titanium group (10% vs 0%, P = .03); however, the authors suggest that metal artifact precluded proper assessment of the graft in the titanium group by MRI. Tunnel volumes also appeared to be equivalent in the 2 groups and were measured with a novel technique that was highly reproducible in the PEEK group secondary to the absence of flare. Conclusion: Two-year clinical analysis of PEEK interference screws for femoral and tibial fixation of ACL reconstructions showed equivalent clinical performance to titanium interference screws. Given the excellent mechanical characteristics, biological compatibility, and absence of metal artifact on MRI, PEEK has become our material of choice for interference screw fixation in ACL reconstruction

Femoral fracture following knee ligament reconstruction surgery due to an unpredictable complication of bioabsorbable screw fixation: a case report and review of literature

We report an unusual case of femoral fracture from minimal trauma, due to the rapid disappearance of a bioabsorbable interference screw used for reconstruction of the posterolateral corner of the knee. The literature on bone tunnel fractures following knee ligament reconstruction surgery is also reviewed

Anterior cruciate ligament reconstruction with suture tape augmentation

The advent of suture tape augmentation has led to increased use in knee, elbow, and ankle ligament repairs and reconstructions. Recent biomechanical analysis of the use of suture tape augmentation have shown superior strength characteristics compared with repair or reconstruction alone. Despite its increased use in extra-articular ligament procedures, its use as an augment to anterior cruciate ligament reconstruction has not been widely described. This article details a simple technique to incorporate the use of suture tape augmentation during concurrent anterior cruciate ligament reconstruction using hamstring autograft

The Evolgate: a method to improve the pullout strength of interference screws in tibial fixation of anterior cruciate ligament reconstruction with doubled gracilis and semitendinosus tendons.

The goal of the study was to investigate the biomechanical properties of a new device for tibial fixation in arthroscopic anterior cruciate ligament reconstruction using doubled semitendinosus and gracilis tendons.Biomechanical study.This study compares the initial pullout strength, stiffness, and failure modes of 7 pairs of 4-strand human semitendinosus and gracilis grafts fixed to porcine tibias using either the Evolgate (Citieffe, Bologna, Italy) or 1 round threaded titanium interference screw. Structural tests of the graft fixation method tibia complexes were performed using a materials testing machine (MTS Bionix 855, Minneapolis, MN) at a strain rate of 50 mm/second.The mean failure load was 1,237 +/- 191 N for the Evolgate and 537 +/- 65 N for the interference screw (P <.05) and the mean stiffness was 168 +/- 37 N/m for the Evolgate and 105 +/- 17 N/m for the interference screws (P < or =.05). Although in all the cases fixed with the Evolgate failure occurred because of tendon rupture inside the tibial tunnel close to the fixation device, in 4 of the 7 cases fixed with interference screws, failure occurred because of tendon slippage at the fixation site.These results indicate that initial pullout strength of hamstring tendon graft interference screw fixation can be significantly increased using the Evolgate. In fact, because the screws purchase only in the cancellous bone, the Evolgate reinforces the walls of the tibial tunnel with a titanium involute, avoiding the loss of fixation strength related to the low density of the cancellous bone of the proximal metaphysis of the tibia