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J Knee Surg 2024; 37(13): 894-901
DOI: 10.1055/a-2344-5195
Original Article

Mechanical Evaluation of Bone–Patellar Tendon–Bone Graft Fixation to the Tibia in ACL Reconstruction: Bone Plug Tensioning and Fixation System versus Interference Screw

Ryo Iuchi
1   Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Japan
,
Konsei Shino
2   Sports Orthopedic Center, Yukioka Hospital, Osaka, Japan
,
Tatsuo Mae
2   Sports Orthopedic Center, Yukioka Hospital, Osaka, Japan
,
Satoshi Yamakawa
3   Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
,
Ken Nakata
3   Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
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Abstract

This study aimed to evaluate the mechanical properties of bone plug fixation to the tibia with a novel device, the Bone plug Tensioning and Fixation (BTF) system.

Forty bone–tendon–bone grafts consisting of the whole patella–patellar tendon–tibial bone plug of 10-mm width and tibiae from the porcine were prepared. After creating a 10-mm tibial tunnel, the tibial bone plug was fixed to the tibia with the BTF system or the interference screw (IFS) to prepare a test specimen of the patella–patellar tendon–tibial bone plug fixed to the tibia. For the graft tension controllability study, a predetermined initial tension of 9.8 or 19.6 N was applied and maintained for 5 minutes. Then the bone plug was fixed to the tibia with the BTF system or IFS in 10 specimens, monitoring the residual tension for an additional 5 minutes. Then, a cyclic loading test and a tension-to-failure test were performed.

The mean difference between the residual tension and the predetermined tension was significantly smaller in BTF fixation (9.8 N → 10.6 ± 2.2 N; 19.6 N → 18.9 ± 2.1 N) than in IFS fixation (9.8 N → 23.4 ± 7.4 N; 19.6 N → 28.9 ± 11.5 N). The mean displacement of the bone plug after cyclic loading was significantly less in the BTF group (1.2 ± 0.6 mm) than in the IFS group (2.2 ± 1.0 mm; p < 0.01). Stiffness was significantly greater in the BTF group (504.6 ± 148.8 N/mm) than in the IFS group (294.7 ± 96.7 N/mm; p < 0.01), whereas the maximum failure loads in the two groups did not differ significantly (724.2 ± 180.3 N in the BTF and 634.8 ± 159.4 N in the IFS groups).

BTF system better performed in graft tension controllability than IFS did. BTF fixation was superior to IFS fixation in the displacement of the bone plug during the cyclic loading test and in stiffness in the tension-to-failure test.

Keywords

ACL reconstruction - BTB graft - graft tension - graft fixation - tibial fixation device - bone plug tensioning and fixation system


Publication History

Received: 06 September 2023

Accepted: 11 June 2024

Accepted Manuscript online:
13 June 2024

Article published online:
27 June 2024

© 2024. Thieme. All rights reserved.

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