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Correlation of bone tunnel diameter with quadrupled hamstring graft fixation strength using a biodegradable
Eric Steenlage1, Jeff C Brand, Darren L Johnson
1Trauma and Reconstructive Surgery, Sports Traumatology & Arthroscopy Service, Charité Campus Virchow Clinic, Humboldt-University, Berlin, Germany.
Summary
A more precise match between bone tunnel and quadrupled hamstring tendon graft (QHT) diameters significantly improved femoral fixation strength. This suggests optimizing graft fixation instrumentation for better surgical outcomes.
Area of Science:
- Orthopedic surgery
- Biomedical engineering
- Sports medicine
Background:
- Quadrupled hamstring tendon grafts (QHT) are commonly used in anterior cruciate ligament (ACL) reconstruction.
- Graft fixation strength is critical for successful surgical outcomes.
- Current fixation methods may have limitations in achieving optimal graft-to-tunnel ratios.
Purpose of the Study:
- To evaluate the impact of bone tunnel diameter precision on the ultimate load at failure of quadrupled hamstring tendon grafts (QHT).
- To determine if a closer match between QHT diameter and bone tunnel diameter enhances fixation strength.
Main Methods:
- Biomechanical testing of cadaver knees (n=17).
- Two groups were established: Group A (1.0-mm increments for graft and tunnel sizing) and Group B (0.5-mm increments).
- Quadrupled hamstring tendon grafts were fixed with biodegradable interference screws and tested to failure.
Main Results:
- Femoral fixation strength significantly increased from 341 N to 530 N (P < .05) in the 0.5-mm increment group compared to the 1.0-mm group.
- Tibial fixation strength showed improvement from 221 N to 308 N (P = .35) with finer increments.
Conclusions:
- A more precise match of bone tunnel diameter to QHT diameter significantly enhances femoral fixation strength.
- Current surgical instrumentation could be improved by offering sleeves and reamers in 0.5-mm increments to optimize graft fixation.