Assessment of initial fixation of endoscopic interference femoral screws with divergent and parallel placement

Divergence of the interference screw placement used for femoral fixation during endoscopically assisted reconstruction of the anterior cruciate ligament has been described. This study is a biomechanical evaluation in 12 pairs of fresh intact bovine knees of femoral interference screws placed divergently and parallel relative to the bone block and its tunnel. One knee of each pair had the interference screw placed in a parallel fashion and the other knee had a 15 degrees divergence from the bone plug. Paired specimens were used to provide an optimal comparison of biomechanical data of the two different screw placements. No statistically significant differences were seen between the two groups when looking at ultimate load, deformation, and stiffness. Mode of failure was of more concern: in 4 of 12 divergent constructs, bone plug pullout occurred compared with only 1 of 12 in the parallel construct. The pullout strength remains high even with divergence of up to 15 degrees between the bone plug and femoral interference screws placed endoscopically.