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Biomechanical evaluation of a new cross-pin technique for the fixation of different sized bone–patellar tendon–bone grafts

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

To overcome the disadvantages of interference-screw fixation of bone–patellar tendon–bone (BPTB) grafts, new fixation techniques for anterior cruciate ligament (ACL) grafts using biodegradable pins have been developed. The hypothesis of the present study was that cross-pin fixation techniques provide a primary stability that is comparable to that of interference screws. A biomechanical in vitro study was discussed. Human BPTB grafts of 8, 9 and 10 mm diameter were fixed in bovine knees with biodegradable cross pins (diameter: 2.0, 2.7 or 3.2 mm) or biodegradable interference screws. Stiffness and ultimate load were evaluated. For 9 and 10 mm BPTB grafts, no statistically significant difference in maximum load and stiffness was found between the four fixation techniques tested. For 8 mm bone blocks the maximum load of the 3.2 mm pins (274.2 N) was significantly lower than for the 2.0 mm pins (479.8 N) and the interference screws (504.0 N). Predominant failure mode in this group was bone-block fracture. Thicker grafts (9 and 10 mm) fixed with the 2.0 mm pins predominantly failed by implant fracture. Femoral fixation of 8, 9 and 10 mm BPTB grafts using cross pins leads to biomechanical properties that are comparable to biodegradable interference screws when tested by a single-cycle load to failure. Cross pins provide a rigid fixation for 9 and 10 mm BPTB grafts.

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Acknowledgements

We want to thank Mr. S. Zander and Mr. A Studt for their expert technical assistance. We would also like to thank Mr. J. Hedderich from the Department of Medical Statistics of the Christian Albrechts University in Kiel for his help with the statistical analysis. The implants used in this study were kindly provided by Ethicon, Mitek Division (Norderstedt, Germany) and by Linvatec Biomaterials (Tampere, Finland). None of the authors received the financial support of any commercial party.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Kaufmann Building, Suite 1011, Pittsburgh, PA 15213, USA

    Thore Zantop & Volker Musahl

  2. Department of Orthopaedic Surgery, University of S-H, Campus Kiel, Michaelisstrasse 1, 24105, Kiel, Germany

    Barbara Welbers & Markus Rümmler

  3. Department of Trauma, Hand and Reconstructive Surgery, University Münster, Waldeyerstrasse 1, 48149, Münster, Germany

    Andre Weimann & Wolf Petersen

  4. Institute for Medical Informatic and Statistical Analysis, University of S-H, Campus Kiel, Brunswicker Strasse 10, 24105, Kiel, Germany

    Jürgen Hedderich

Authors
  1. Thore Zantop
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  2. Barbara Welbers
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  3. Andre Weimann
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  4. Markus Rümmler
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  7. Wolf Petersen
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Correspondence to Wolf Petersen.

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Zantop, T., Welbers, B., Weimann, A. et al. Biomechanical evaluation of a new cross-pin technique for the fixation of different sized bone–patellar tendon–bone grafts. Knee Surg Sports Traumatol Arthrosc 12, 520–527 (2004). https://doi.org/10.1007/s00167-004-0509-5

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