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First published on August 27, 2007, doi:10.1177/0363546507306162
This version was published on December 1, 2007
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The American Journal of Sports Medicine 35:2073-2082 (2007)
© 2007 American Orthopaedic Society for Sports Medicine

High-Stiffness Distal Fixation Restores Anterior Laxity and Stiffness as Well as Joint Line Fixation With an Interference Screw

David Liu-Barba, MS, Stephen M. Howell, MD*,{dagger} and Maury L. Hull, PhD*

* Department of Mechanical Engineering, University of California at Davis, Davis, California

{dagger} Address correspondence to Stephen M. Howell, MD, Department of Mechanical Engineering, University of California, 8100 Timberlake, Suite F, Sacramento, CA 95823 (e-mail: sebhowell{at}mac.com).

Background: Fixation of an anterior cruciate ligament graft at the joint line with an interference screw restores anterior laxity better than low-stiffness distal fixation with double staples and sutures tied to a post at implantation in porcine bone.

Hypothesis: Fixation of an anterior cruciate ligament graft with a high-stiffness distal fixation device restores anterior laxity and knee stiffness as well as joint line fixation with an interference screw in human bone.

Study Design: Controlled laboratory study.

Methods: Eleven cadaveric knees with foam reinforcement of the bone were reconstructed with a double-looped tendon graft and fixed with an interference screw and 3 high-stiffness methods of fixation (tandem washer, WasherLoc, and WasherLoc with bone dowel). Anterior laxity at 225 and 110 N of anterior load and knee stiffness were measured at 0° , 30° , 60° , 90° , and 120° of flexion with a 6 degrees of freedom load application system.

Results: The increase in anterior laxity and knee stiffness with the interference screw was not significantly different from that with the high-stiffness distal methods.

Conclusion: In the human knee, the use of high-stiffness fixation devices placed distal to the joint line restored anterior laxity and knee stiffness as well as joint line fixation with an interference screw at implantation.

Clinical Relevance: The stiffness provided by each method of fixation should be considered along with the length of the graft when determining anterior laxity and knee stiffness.

Key Words: anterior cruciate ligament (ACL) • knee stiffness • fixation level • fixation device • fixation technique • graft tension • anterior laxity






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