LIVRE JDG 2016

J. CHAPPUIS, J. BARTH, J.C. PANISSET

During the first 6 to 12 weeks after surgery,

when conversion from mechanical to biologic

fixation is occuring, the fixation must be able to

withstand the demands of an accelerated

rehabilitation program.

There are a variety of methods by which the

bone and soft tissue grafts can be fixed, and this

can be done either in the bone tunnel or through

a cortical based fixation away from the joint [3]

(fig. 1). Historically, the revolution was the

Kurosaka screw [4] (fig. 2).

Fixation strength is especially important on the

tibial side, which is usually the site of fixation

failure, because the metaphyseal region of the

tibia has less bone density than the femur and

the graft experiences forces that are more

collinear within the tibial tunnel [5].

Efficiency of graft fixation depends on the

characteristics of the fixation devices, on the

site of fixation (aperture or nonaperture), on the

density of the bone (tibia or femur) and on the

type of graft.

Fig. 1:

From Kousa and coworkers

[3]