Can an expansion device be used in anterior cruciate ligament reconstruction? An in vitro study of soft tissue graft tibial fixation

Abstract

Background The purpose of this study was to compare the mechanical properties of an interference screw with an expansion device in anterior cruciate ligament (ACL) reconstruction. Methods A total of 52 porcine tibia and 20 polyurethane foam blocks (0.16 g/cm3) were used. Forty pullout tests were carried out to combine the two types of bones – surrogate and porcine – with the two fixation systems: interference screw and expansion device (n = 10 per group). Thirty-two cyclic tests (n = 8 per group) were carried out with both fixation devices in porcine bone at two different force amplitudes (100 N and 200 N). Results Stiffness and load values (mean ± SD) at six millimeters of displacement for the expansion device and the interference screw were 74 ± 33 N/mm, 318 ± 135 N, and 52 ± 28 N/mm, 205 ± 70 N, respectively, showing a difference in stiffness (P = 0.016) and load at six millimeters of displacement (P = 0.001). No correlation between insertion torque and the ultimate failure load was found for both fixation devices tested. In cyclic tests, significantly higher (P < 0.001) numbers of cycles (mean ± SD) were reached with the expansion device (81,014 ± 30,291 at 100 N; 13,462 ± 11,351 at 200 N) than with the interference screw (15,100 ± 8623 at 100 N; 343 ± 113 at 200 N) at six millimeters of displacement. Conclusion The use of an expansion device for ACL reconstructions seemed to be a promising alternative to an interference screw. Insertion torque alone was not a useful predictor of graft fixation strength in ACL reconstructions.