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Compaction of a Bone Dowel in the Tibial Tunnel Improves the Fixation Stiffness of a Soft Tissue Anterior Cruciate Ligament Graft

An In Vitro Study in Calf Tibia

Stephen M. Howell, MD^*,, Phil Roos, MS and Maury L. Hull, PhD

From the Department of Mechanical Engineering and the Biomedical Engineering Graduate Group, Department of Mechanical Engineering, University of California at Davis, Davis, California

^* Address correspondence to Stephen M. Howell, MD, 8100 Timberlake Way, Suite F, Sacramento, CA 95823 (e-mail: sebhowell{at}mac.com).

Background: Despite increasing attention on fixation of a soft tissue anterior cruciate ligament graft in the tibia, there have been no studies on the use of a bone dowel as a joint line fixation device for promoting fixation properties, especially stiffness at the time of implantation.

Purpose: To determine whether compacting a bone dowel into the tibial tunnel improves fixation stiffness, yield load, and resistance to slippage of a soft tissue anterior cruciate ligament graft.

Study Design: Controlled laboratory study.

Methods: A double-looped tendon graft was fixed at the distal end of the tibial tunnel with a WasherLoc in 24 calf tibias. The tibial tunnels were treated with or without a dowel of cancellous bone. The bone dowel was harvested from the tibial tunnel and then compacted into a tapered space anterior to the anterior cruciate ligament graft as a joint line fixation device. A cyclic load and measurement test was administered to determine fixation stiffness, yield load, slippage, and failure mode.

Results: The specimens with the bone dowel had 58 N/mm more stiffness (P = .04); however, the yield load and resistance to slippage were similar in specimens with and without the bone dowel.

Conclusions: A bone dowel harvested from the tibial tunnel can be used as a joint line fixation device in series with a distal fixation method to improve initial fixation stiffness and increase the fit, which is known to enhance tendon graft-to-bone healing in the tibia.

Key Words: anterior cruciate ligament (ACL) • graft healing • bone stiffness fixation

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