A comparison of four tibial-fixation systems in hamstring-graft anterior ligament reconstruction

The aim of this study was to evaluate at time-zero four tibial fixations on four major criteria: the elongation and cyclic stiffness of the hamstring graft construct under cyclic loading, the yield load and pullout stiffness under load at failure. Four fixation systems were tested: the Delta screw, the WasherLoc, the TightRope Reverse and the tape locking screw on 32 tibiae of adult pigs using 32 pairs of human semitendinosus and gracilis tendons. Two tests were performed: cyclic tests using loads at 70-220 N, to measure the elongation at the end of the cycles, followed by load-to-failure testing to measure the yield load and the cyclic stiffness. The mean elongation was 1.23 mm for the TLS, 3.81 mm for the Delta, 3.59 mm for the WasherLoc and 3.91 mm for the TightRope. The mean yield loads and SD were 1,015 ± 129 N for the TLS, 844 ± 394 N for the Delta, 511 ± 95 N for the WasherLoc and 567 ± 112 N for the TightRope. The results showed the significant superiority of TLS and Delta over WasherLoc and tibial TightRope in regard to yield load. The results showed the significant superiority of TLS over the other fixations in regard to slippage. The TLS system and the Delta screw provide a better quality of primary fixation to the tibia, but further in vitro studies are needed.