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Does a combined screw and dowel construct improve tibial fixation during anterior cruciate ligament reconstruction?

Laumonerie, Pierre and Tibbo, Meagan E. and Laumond, Gregoire and Barbier, Dominique and Assemat, Pauline and Swider, Pascal and Accadbled, Franck Does a combined screw and dowel construct improve tibial fixation during anterior cruciate ligament reconstruction? ( In Press: 2021) European Journal of Orthopaedic Surgery & Traumatology. ISSN 1633-8065

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Official URL: https://doi.org/10.1007/s00590-021-03049-2

Abstract

Purpose: The aims of the present study were to compare the biomechanical properties of tibial fixation in hamstring-graft ACL reconstruction using interference screw and a novel combination interference screw and dowel construct. Material and methods: We compared the fixation of 30 (2- and 4-stranded gracilis and semitendinosis tendons) in 15 fresh-frozen porcine tibiae with a biocomposite resorbable interference screw (Group 1) and a screw and dowel construct (Group 2). Each graft was subjected to load-to-failure testing (50 mm/min) to determine maximum load, displacement at failure and pullout strength. Results: There were no significant differences between the biomechanical properties of the constructs. Multivariate analysis demonstrated that combination constructs (β = 140.20, p = 0.043), screw diameter (β = 185, p = 0.006) and 4-strand grafts (β = 51, p = 0.050) were associated with a significant increase in load at failure. Larger screw diameter was associated with increased construct stiffness (β = 20.15, p = 0.020). Conclusion: The screw and dowel construct led to significantly increased fixation properties compared to interference screws alone in a porcine model. Increased screw diameter and utilization of 4-strand ACL grafts also led to improvement in load-to-failure of the construct. However, this is an in vitro study and additional investigations are needed to determine whether the results are reproducible in vivo. Level of evidence: Level V; Biomechanical study.

Item Type:Article
Audience (journal):International peer-reviewed journal
Uncontrolled Keywords:
Institution:French research institutions > Centre National de la Recherche Scientifique - CNRS (FRANCE)
Université de Toulouse > Institut National Polytechnique de Toulouse - Toulouse INP (FRANCE)
Université de Toulouse > Université Toulouse III - Paul Sabatier - UT3 (FRANCE)
Other partners > Centre Hospitalier Universitaire de Bordeaux - CHU (FRANCE)
Other partners > Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE)
Other partners > Mayo Clinic (USA)
Laboratory name:
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Deposited On:15 Jun 2021 15:33

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