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Novel press-fit technique of patellar bone plug in anterior cruciate ligament reconstruction is comparable to interference screw fixation

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Conventional press-fit technique for anterior cruciate ligament reconstruction (ACLR) is performed with extraction drilling of the femoral bone tunnel and manual sha** of the patellar bone plug. However, the disadvantages of this technique include variation in bone plug size and, thus, the strength of the press-fit fixation, bone loss with debris distribution within the knee joint, potential heat necrosis, and metal wear debris due to abrasion of the guide wire. To overcome these disadvantages, a novel technique involving punching of the femoral bone tunnel and standardized compression of the bone plug was introduced. In this study, the fixation strength and apparent stiffness were tested and compared to that of the gold-standard interference screw fixation technique in three flexion angle configurations (0°/45°/90°) in a porcine model. We hypothesized that the newly developed standardized press fit fixation would not be inferior to the gold standard method.

Methods

Sixty skeletally mature porcine knees (30 pairs) were used. Full-thickness central third patellar tendon strips were harvested, including a patellar bone cylinder of 9.5 mm in diameter. The specimens were randomly assigned to 10 pairs per loading angle (0°, 45°, 90°). One side of each pair was prepared with the press-fit technique, and the contra-lateral side was prepared with interference screw fixation. Equivalent numbers of left- and right-sided samples were used for both fixation systems. A three-way multifactor ANOVA was carried out to check for the influence of (a) fixation type, (b) flexion angle, and (c) side of the bone pair.

Results

The primary fixation strength of femoral press-fit graft fixation with punched tunnels and standardized bone plug compression did not differ significantly from that of interference screw fixation (p = 0.51), which had mean loads to failure of 422.4 ± 134.6 N and 445.4 ± 135.8 N, respectively. The flexion angle had a significant influence on the maximal load to failure (p = 0.01). Load values were highest in 45° flexion for both fixations. The anatomical side R/L was not a statistically significant factor (p = 0.79).

Conclusion

The primary fixation strength of femoral press-fit graft fixation with punched femoral tunnels and standardized bone plug compression is equivalent to that of interference screw fixation in a porcine model. Therefore, the procedure represents an effective method for ACL reconstruction with patellar or quadriceps tendon autografts including a patellar bone plug.

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Abbreviations

ACL(R):

Anterior cruciate ligament (reconstruction)

IS:

Interference screw

PF:

Press-fit

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Acknowledgements

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Funding

Funding was received from the Lindenhof Foundation, Bern, Switzerland.

Author information

Authors and Affiliations

  1. Sonnenhof Orthopaedic Center, Buchserstrasse 30, 3006, Bern, Switzerland

    Janosch Häberli, Philipp Henle & Stefan Eggli

  2. Hospital Center Biel, Vogelsang 84, 2501, Biel, Switzerland

    Maximilian Heilgemeir

  3. Laboratory for Mechanical Systems Engineering, Empa, Swiss Federal Laboratories for Materials Science and Technology, 8600, Dübendorf, Switzerland

    Sebastian Valet & Ameet Aiyangar

  4. Ignite Concepts, Hüslerhofstrasse 6, 4513, Langendorf, Switzerland

    Tom Overes

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Contributions

JH designed the study, composed the manuscript concept, and wrote the manuscript. SV, AA, and TO conducted the biomechanical tests, performed all statistical analyses, and edited the complete manuscript. MH and JH operated on all cases and helped in editing the final draft version of the manuscript. SE supervised the study and helped in editing the final draft version of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Janosch Häberli.

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Häberli, J., Heilgemeir, M., Valet, S. et al. Novel press-fit technique of patellar bone plug in anterior cruciate ligament reconstruction is comparable to interference screw fixation. Arch Orthop Trauma Surg 142, 1963–1970 (2022). https://doi.org/10.1007/s00402-021-04137-y

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