Biomechanical testing of implant free wedge shaped bone block fixation for bone patellar tendon bone anterior cruciate ligament reconstruction in a bovine model

The use of an interference fit wedged bone plug to provide fixation in the tibial tunnel when using bone-patellar tendon-bone autograft for anterior cruciate ligament reconstruction offers many theoretic advantages including the potential to offer a more economical and biological alternative to screw fixation. This technique has not been subjected to biomechanical testing.

We hypothesised that a wedged bone plug fixation technique provides equivalent tensile load to failure as titanium interference screw fixation.

Methods: In a controlled laboratory setting, anterior cruciate ligament reconstruction was performed in 36 bovine knees using bone-patella-bone autograft. In 20 knees tibial fixation relied upon a standard cuboid bone block and interference screw.

In eight knees a wedge shaped bone block with an 11mm by 10mm base without a screw was used. In a further eight knees a similar wedge with a 13mm by 10mm base was used.

Each specimen used a standard 10mm tibial tunnel. The reconstructions were tested biomechanically in a physiological environment using an Instron machine to compare ultimate failure loads and modes of failure.

Results: Statistical analysis revealed no significant difference between wedge fixation and screw fixation (p=0.16), or between individual groups (interference screw versus 11 mm versus 13 mm wedge fixation) (P=0.35).

Conclusions: Tibial tunnel fixation using an impacted wedge shaped bone block in anterior cruciate ligament reconstruction has comparable ultimate tensile strength to titanium interference screw fixation.

Author: Charles Willis-OwenTrevor HearnGregory KeeneJohn Costi
Credits/Source: Journal of Orthopaedic Surgery and Research 2010, 5:66

Published on: 2010-09-02

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