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Hyperflexion and Femoral Interference Screw Insertion in ACL Reconstruction
Mark E Steiner1, David Wing1, Kempland C Walley2
1Department of Orthopedic Surgery Sports Section, New England Baptist Hospital, Boston, Massachusetts, USA.
Orthopaedic Journal of Sports Medicine
|August 16, 2018
Summary
Knee hyperflexion is not necessary for femoral interference screw insertion in anterior cruciate ligament (ACL) reconstructions. Both rigid and flexible screwdrivers yield similar screw-graft divergence and fixation strength, simplifying the surgical procedure.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Anatomy
Background:
- Anatomic anterior cruciate ligament (ACL) reconstructions often utilize flexible reamers without knee hyperflexion.
- The necessity of knee hyperflexion for femoral interference screw insertion in ACL reconstruction remains unclear.
Purpose of the Study:
- To compare femoral screw-graft divergence in anatomic ACL reconstructions using endoscopic interference screws placed without knee hyperflexion.
- To evaluate the impact of flexible versus rigid screwdrivers on screw placement and graft fixation.
Main Methods:
- Controlled laboratory study involving ten matched pairs of cadaveric knees.
- Bone-tendon-bone graft ACL reconstructions were performed with anatomic femoral tunnels and 90° knee flexion.
- Femoral interference screws were inserted using either a flexible or a rigid screwdriver, with subsequent CT imaging and biomechanical testing.
Main Results:
- No significant difference in mean screw-graft divergence was observed between rigid (12.07° ± 4.04°) and flexible (10.68° ± 3.23°) screwdrivers (P = .35).
- Cyclic and static biomechanical tests showed no significant differences in displacement, yield load, or maximum load between the two screwdriver types.
Conclusions:
- Femoral interference screw insertion in ACL reconstruction can be performed without knee hyperflexion.
- The choice between rigid and flexible screwdrivers does not significantly impact screw-graft divergence or fixation strength.
- These findings suggest a simplified approach to ACL reconstruction surgery.
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