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

Authors

  • Anderson de Aquino Santos Universidade Federal de Sao Paulo, Escola Paulista de Medicina https://orcid.org/0000-0002-8457-2764
  • Mario Carneiro-Filho Universidade Federal de Sao Paulo, Escola Paulista de Medicina
  • Roberto Freire da Mota e Albuquerque Universidade de Sao Paulo, Faculdade de Medicina https://orcid.org/0000-0002-0848-9475
  • João Paulo Freire Martins de Moura Universidade Federal de Sao Paulo, Escola Paulista de Medicina
  • Carlos Eduardo Franciozi Universidade Federal de Sao Paulo, Escola Paulista de Medicina
  • Marcus Vinícius Malheiros Luzo Universidade Federal de Sao Paulo, Escola Paulista de Medicina

DOI:

https://doi.org/10.6061/clinics/2020/e1123

Keywords:

Anterior Cruciate Ligament Reconstruction, Knee Lesions, Surgical Fixation Devices, Mechanics

Abstract

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.

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Published

2020-04-30

How to Cite

Santos, A. de A., Carneiro-Filho, M., Albuquerque, R. F. da M. e, Moura, J. P. F. M. de, Franciozi, C. E., & Luzo, M. V. M. (2020). Mechanical evaluation of tibial fixation of the hamstring tendon in anterior cruciate ligament double-bundle reconstruction with and without interference screws. Clinics, 75, e1123. https://doi.org/10.6061/clinics/2020/e1123

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Original Articles