Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleBiomechanical Evaluation of a Novel Application of a Fixation Device for Bone-Tendon-Bone Graft (EndoButton CL BTB) to Soft-Tissue Grafts in Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction
Section snippets
Study Design
We used 20 fresh-frozen hindlimbs from fully mature Landrace Lange White-Durou pigs weighing approximately 100 kg in this study, which was carried out at the Institute of Animal Experimentation, Hokkaido University School of Medicine, Sapporo, Japan, under the rules and regulations of the Animal Care and Use Committee. Two flexor digitorum profundus tendons harvested from each hindlimb were used as substitutes for the human hamstring tendon, because previous studies have shown that the material
Results
The cross-sectional area of the doubled tendon measuring 6 mm in diameter was 24.8 ± 4.9 mm2 and 26.5 ± 4.8 mm2 in group I (ECL) and group II (ECL-BTB), respectively. The cross-sectional area of the doubled tendon measuring 7 mm in diameter was 34.8 ± 5.7 mm2 and 35.9 ± 6.0 mm2 in group III (ECL) and group IV (ECL-BTB), respectively. The 2-way ANOVA indicated no significant difference (P = .4143) in the cross-sectional area between the 2 fixation devices (ECL and ECL-BTB).
On tensile testing,
Discussion
This biomechanical study was conducted to evaluate the unique clinical idea that the ECL-BTB developed for bone-tendon-bone graft fixation could be applied flexor tendon graft fixation. This study showed that there was no significant difference in the maximum load and elongation at failure of the tendon-device composite between the ECL-BTB and the ECL. Previous studies reported on the fixation strength of various hamstring tendon graft fixation devices (ECL, Bone Mulch screw [Biomet, Warsaw,
Conclusions
This study has shown that the maximum load of the flexor tendon graft connected to the ECL-BTB is similar to that of the ECL whereas the stiffness of the ECL-BTB is inferior to that of the ECL.
Acknowledgment
The authors thank Smith & Nephew Endoscopy Japan for donating the fixation devices evaluated in this study.
References (21)
- et al.
Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction
Arthroscopy
(2001) - et al.
Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts
Arthroscopy
(2004) - et al.
Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: Comparisons among 3 different procedures
Arthroscopy
(2006) - et al.
Second-look arthroscopic evaluations of anatomic double-bundle anterior cruciate ligament reconstruction: Relation with postoperative knee stability
Arthroscopy
(2007) - et al.
Biomechanical comparisons of anterior cruciate ligament reconstruction procedures with flexor tendon graft
J Orthop Sci
(2000) - et al.
The effect of electrothermal shrinkage on biomechanical properties of the anterior cruciate ligamentAn experimental study
Arthroscopy
(2005) - et al.
Graft-bone motion and tensile properties of hamstring and patellar tendon anterior cruciate ligament femoral graft fixation under cyclic loading
Arthroscopy
(2004) - et al.
Interference screw fixation of doubled flexor tendon graft in anterior cruciate ligament reconstruction—Biomechanical evaluation with cyclic elongation
Clin Biomech
(2000) - et al.
Comparison between different femoral fixation devices for ACL reconstruction with doubled hamstring tendon graft: A biomechanical analysis
Arthroscopy
(2006) - et al.
The effect of cyclic displacement on the biomechanical characteristics of anterior cruciate ligament reconstructions
Am J Sports Med
(1999)
Cited by (14)
Double-bundle anterior cruciate ligament reconstruction using autologous hamstring tendon hybrid grafts in a patient with hypermobile Ehlers-Danlos Syndrome: A case report
2022, KneeCitation Excerpt :A commercially available polyester tape (Leeds-Keio artificial ligament; Neoligaments, Leeds, England) was mechanically connected in a series at an unlooped end of the folded tendon [12,13]. An Endobutton CL BTB (Smith & Nephew, Andover, MA) was attached to the looped end [14]. The diameter of the AM and PL grafts were 7 mm and 6.5 mm, respectively.
Suspensory Fixation Device for Use With Bone–Patellar Tendon–Bone Grafts
2017, Arthroscopy TechniquesA novel repair method for the treatment of acute Achilles tendon rupture with minimally invasive approach using button implant: A biomechanical study
2013, Foot and Ankle SurgeryCitation Excerpt :To our knowledge, this is the first study that tests biomechanical properties and describes the operative technique of Endobutton assisted modified Bunnell technique for Achilles tendon ruptures. Endobutton techniques have been widely used for the treatment of several injuries such as acromioclavicular separation [24,25], distal biceps brachii rupture [26,27], distal tibiofibular syndesmotic injury [28–30] and reconstruction of knee ligaments [31,32]. The use of an Endobutton has not been previously described for the treatment of acute Achilles tendon ruptures in the literature.
A pilot study of anatomic double-bundle anterior cruciate ligament reconstruction with ligament remnant tissue preservation
2012, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :Each tendon was doubled over, and a commercially available polyester tape (Leeds-Keio Artificial Ligament; Neoligaments, Leeds, United Kingdom) was mechanically connected at an unlooped end of the doubled tendons, by the previously reported technique25,29 (Fig 6). Immediately before grafting, an EndoButton CL BTB device (Smith & Nephew Endoscopy, Andover, MA) was attached at the looped end, based on our biomechanical study.31 First, the PL graft was introduced through the tibial tunnel and the remnant tissue into the femoral tunnel, with fixation with an EndoButton (Fig 3F).
Quadriceps tendon vs hamstring autograft in primary ACL reconstruction – a comparative study with minimum two-year follow-up
2022, Acta Orthopaedica BelgicaContinuous-Loop Tape Technique Has Greater Stiffness and Less Elongation Compared With Tied-Suture Fixation of Full-Thickness All–Soft Tissue Quadriceps Tendon Autografts
2021, Orthopaedic Journal of Sports Medicine
Supported by a Grant-in-Aid for Scientific Research (No. 20240045) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. The authors report no conflict of interest.