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Does a combined screw and dowel construct improve tibial fixation during anterior cruciate ligament reconstruction?

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The aims of the present study were to compare the biomechanical properties of tibial fixation in hamstring-graft ACL reconstruction using interference screw and a novel combination interference screw and dowel construct.

Material and Methods

We compared the fixation of 30 (2- and 4-stranded gracilis and semitendinosis tendons) in 15 fresh-frozen porcine tibiae with a biocomposite resorbable interference screw (Group 1) and a screw and dowel construct (Group 2). Each graft was subjected to load-to-failure testing (50 mm/min) to determine maximum load, displacement at failure and pullout strength.

Results

There were no significant differences between the biomechanical properties of the constructs. Multivariate analysis demonstrated that combination constructs (β = 140.20, p = 0.043), screw diameter (β = 185, p = 0.006) and 4-strand grafts (β = 51, p = 0.050) were associated with a significant increase in load at failure. Larger screw diameter was associated with increased construct stiffness (β = 20.15, p = 0.020).

Conclusion

The screw and dowel construct led to significantly increased fixation properties compared to interference screws alone in a porcine model. Increased screw diameter and utilization of 4-strand ACL grafts also led to improvement in load-to-failure of the construct. However, this is an in vitro study and additional investigations are needed to determine whether the results are reproducible in vivo.

Level of evidence

Level V; Biomechanical study.

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Fig. 1
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Abbreviations

ACL:

Anterior cruciate ligament

BMD:

Bone mineral density

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Funding

This research received no specific grant from any funding agency in the public, commercial or not for profit sectors.

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Author notes

  1. Pierre Laumonerie

    Present address: , Place du Docteur Baylac, 31059, Toulouse, France

Authors and Affiliations

  1. Department of Orthopaedics, Hôpital Pellegrin, 33000, Bordeaux, France

    Pierre Laumonerie

  2. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Meagan E. Tibbo

  3. Department of Orthopaedics, Children’s Hospital, CHU de Toulouse, Toulouse, France

    Gregoire Laumond, Dominique Barbier & Franck Accadbled

  4. IMFT UMR CNRS 5502, University of Toulouse, CHU de Toulouse, Toulouse, France

    Gregoire Laumond, Dominique Barbier, Pauline Assemat, Pascal Swider & Franck Accadbled

  5. Place du Docteur Baylac, 31059, Toulouse, France

    Gregoire Laumond

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  1. Pierre Laumonerie
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Contributions

PL contributed to data analysis and interpretation, critical revisions, manuscript review, statistical analysis. MET was involved in data analysis and interpretation, critical revisions, manuscript review. GL and DB contributed to data acquisition. PA was involved in data acquisition, study design, data analysis and interpretation, critical revisions, manuscript review, administration, technical and material support. PS and FA contributed to study design, data analysis and interpretation, critical revisions, manuscript review, administration, technical and material support, study supervision.

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Correspondence to Pierre Laumonerie.

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Laumonerie, P., Tibbo, M.E., Laumond, G. et al. Does a combined screw and dowel construct improve tibial fixation during anterior cruciate ligament reconstruction?. Eur J Orthop Surg Traumatol 32, 759–765 (2022). https://doi.org/10.1007/s00590-021-03049-2

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  • DOI: https://doi.org/10.1007/s00590-021-03049-2

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