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GRAFT FIXATION
79
TIBIAL FIXATION
For BPTB graft, as for femoral fixation,
interference screws are more commonly used
but staples and screw post and suture can also
be used.
For hamstring and other soft tissue grafts,
similar to bone plug fixation, soft tissue fixation
on the tibial side can be achieved with the use
of interference screws, staples, a screw and
washer, or a screw post and suture.
But this is usually the site of fixation failure
mostly by slippage because there is no bone plug
and it seems that a double fixation should be the
best option when using screw fixation. Another
option may be the use of adjustable suspensory
device such as Tightrope (Arthrex) or Pull-up
(SBM), for example, but further studies are
needed to evaluate these devices on the tibial
side and to be sure there is no distension.
Robert and coworkers have shown in an in
vitro study the superiority of the tape locking
screw (TLS FH Orthopedics) and the Delta
Screw (Arthrex) over the Washerlock (Biomet)
and Tightrope (Arthrex), but further clinical
studies are needed [10].
CONCLUSION
Actually, there is no ideal fixation devices.
For fixation of bone plugs, interference screws
remain the gold standard.
The surgeon can either use a metal or a
bioabsorbable screw.
There is currently no recognized gold standard
for soft tissue fixation, and the surgeon is
encouraged to weigh the risks and benefits of
using different devices.
LITERATURE
[1] BRAND J, WEILER A, CABORN DNM, BROWN
CH, JOHNSON DL. Graft fixation in cruciate ligament
reconstruction.
Am J Sports Med 2000 Sep-Oct; 28(5):
761-74.
[2] NOYES FR, BUTLER DL, GROOD ES,
et al.
Biomechanical analysis of human ligament grafts used in
knee-ligament repairs and reconstructions.
J Bone Joint Surg
Am 1984 Mar; 66(3): 344-52.
[3] KOUSA P, JARVINEN TLN, VIHAVAINEN M,
et al.
The fixation strength of six hamstring tendon graft fixation
devices in anterior cruciate ligament reconstruction-Part I:
Femoral site and Part II: Tibial site.
Am J Sports Med 2003
Mar-Apr; 31(2): 174-88.
[4] KUROSAKA M, YOSHIYA S, ANDRISH JT. A
biomechanical comparison of different surgical techniques
of graft fixation in anterior cruciate ligament reconstruction.
Am J Sports Med 1987 May-Jun; 15(3): 225-9.
[5] WEST RV, HARNER CD. Graft selection in anterior
cruciate ligament reconstruction.
J Am Acad Orthop Surg
2005 May-Jun; 13(3): 197-207.
[6] 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 2004 Nov;
12(6): 520-7.
[7] ARNOLD MP, BURGER LD, WIRZ D
et al.
The
biomechanical strenght of a hardware-free femoral press-fit
method for ACL bone-tendon-bone graft fixation.
Knee Surg
Sports Traumatol Arthrosc 2016 Jan 7.
[8] BROWN CH J
R
, WILSON DR, HECKER AT
et al.
Graft-bone motion and tensile properties of hamstring and
patellar tendon anterior cruciate ligament femoral graft
fixation under cyclic loading.
Arthroscopy 2004 Nov; 20(9):
922-35.
[9] BARROW AE, PILIA M, GUDA T
, et al.
Femoral
suspension devices for anterior cruciate ligament
reconstruction: do adjustabl loops lengthen?
Am J Sports
Med 2014 Feb; 42(2): 343-9.
[10] ROBERT H, BOWEN M, ODRY G
et al.
A comparison
of four tibial-fixation systems in hamstring-graft anterior
ligament reconstruction.
Eur J Orthop Surg Traumatol 2015
Feb; 25(2): 339-47.