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Arthroscopy. 2010 Sep;26(9 Suppl):S35-40. doi: 10.1016/j.arthro.2010.01.018. Epub 2010 Jul 7.

Stiffer fixation of the tibial double-tunnel anterior cruciate ligament complex versus the single tunnel: a biomechanical study.

Author information

1
Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands. d.meuffels@erasmusmc.nl

Abstract

PURPOSE:

The primary objective of this study was to evaluate the difference in graft pullout forces, stiffness, and failure mode of double-bundle anterior cruciate ligament (ACL) reconstruction of the tibial insertion by use of a single tunnel compared with a double-tunnel technique with interference screw fixation.

METHODS:

ACL reconstruction on the tibial side was performed on 40 fresh-frozen porcine knees (mean bone mineral density of 0.64 g/cm(2) measured by dual-energy x-ray absorptiometry scan), randomly assigned to the single- or double-tunnel group. Interference screw fixation of the soft-tissue graft was used for both types of tibial reconstruction. Maximum failure load, stiffness, and failure mode were recorded.

RESULTS:

There was no significant difference in maximum failure load between the single-tunnel group (400 +/- 26 N) and double-tunnel group (440 +/- 20 N). Stiffness of the tibial tunnel complex was significantly higher in the double-tunnel group (76 +/- 3 N/mm) than in the single-tunnel group (62 +/- 4 N/mm) (P = .013). All but 2 grafts (38 of 40) failed by slippage of the tendon past the interference screw.

CONCLUSIONS:

There was significantly stiffer fixation of the tibial double-tunnel ACL complex when compared with the single tunnel. Our study did not show a different failure mode for the double-tunnel reconstruction compared with the single-tunnel reconstruction.

CLINICAL RELEVANCE:

This study shows a biomechanical advantage with no potential deleterious side effects for fixation of the ACL with a double-tunnel technique on the tibial side.

PMID:
20615655
DOI:
10.1016/j.arthro.2010.01.018
[Indexed for MEDLINE]

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