Controversies in the Technical Aspects of ACL Reconstruction by Norimasa Nakamura Stefano Zaffagnini Robert G. Marx & Volker Musahl

Author:Norimasa Nakamura, Stefano Zaffagnini, Robert G. Marx & Volker Musahl
Language: eng
Format: epub
Publisher: Springer Berlin Heidelberg, Berlin, Heidelberg

Fig. 26.3Location of ACL graft fixation does not affect functional outcomes

26.5.2 Interference Screws

Interference screws achieve aperture intratunnel fixation by stabilizing the graft close to the joint line. Interference screws have a long history of clinical success for both BPTB and HT autograft fixation [48]. One concern with interference screws for soft tissue grafts is that compressing the graft may affect its mechanical properties and biologic incorporation. In a sheep model of ACL reconstruction with autograft Achilles tendon fixed with biodegradable screws, the site of failure of all the grafts at 6 and 9 weeks postoperatively was the screw insertion site [65].

The ultimate load to failure of interference screws has been reported in several studies and ranges between 390 N [42] and 790 N [31]. However, many different parameters may influence fixation by interference screws, including the length and diameter of the screw, the position of the screw, its divergence, the size of the gap between the graft and tunnel diameter, the relative difference between tunnel size relative to screw size, corticocancellous versus cancellous fixation, and the torque of insertion of the screw.

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