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Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor.
Arthroscopy. 2012 May; 28(5):681-7.A

Abstract

PURPOSE

To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading.

METHODS

Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees.

RESULTS

Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P < .05). The MaxBraid and OrthoCord groups had higher failure loads than the suture anchor group (P < .05). The MaxBraid group also had a higher failure load than the Hi-Fi group (P < .05). Stiffness was not statistically different for the various tested constructs. After 100 cycles, the EndoButton group had less displacement than the FiberWire, UltraBraid, MaxBraid, and Hi-Fi groups (P < .05). The suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P < .05). The displacements of the different tested constructs between 100 and 500 cycles and total displacements after 500 cycles were not statistically different. The predominant failure mode was suture rupture.

CONCLUSIONS

Under cyclic loading conditions in an ovine model, EndoButton fixation of tibial eminence fractures provided greater initial fixation strength than suture anchor fixation or fixation with various high-strength sutures except for OrthoCord.

CLINICAL RELEVANCE

During initial cyclic loading of ACL tibial eminence fractures, the strength of the repair construct should be taken into consideration because conventional suture repair even with ultrahigh-molecular-weight polyethylene sutures may not provide enough strength.

Authors+Show Affiliations

Department of Orthopaedics and Traumatology, Mustafa Kemal University, Hatay, Turkey. onurhapa@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

22284410

Citation

Hapa, Onur, et al. "Biomechanical Comparison of Tibial Eminence Fracture Fixation With High-strength Suture, EndoButton, and Suture Anchor." Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 28, no. 5, 2012, pp. 681-7.
Hapa O, Barber FA, Süner G, et al. Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. Arthroscopy. 2012;28(5):681-7.
Hapa, O., Barber, F. A., Süner, G., Özden, R., Davul, S., Bozdağ, E., & Sünbüloğlu, E. (2012). Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 28(5), 681-7. https://doi.org/10.1016/j.arthro.2011.10.026
Hapa O, et al. Biomechanical Comparison of Tibial Eminence Fracture Fixation With High-strength Suture, EndoButton, and Suture Anchor. Arthroscopy. 2012;28(5):681-7. PubMed PMID: 22284410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Biomechanical comparison of tibial eminence fracture fixation with high-strength suture, EndoButton, and suture anchor. AU - Hapa,Onur, AU - Barber,F Alan, AU - Süner,Ganim, AU - Özden,Raif, AU - Davul,Serkan, AU - Bozdağ,Ergun, AU - Sünbüloğlu,Emin, Y1 - 2012/01/30/ PY - 2011/05/13/received PY - 2011/10/28/revised PY - 2011/10/28/accepted PY - 2012/1/31/entrez PY - 2012/1/31/pubmed PY - 2012/8/23/medline SP - 681 EP - 7 JF - Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association JO - Arthroscopy VL - 28 IS - 5 N2 - PURPOSE: To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading. METHODS: Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees. RESULTS: Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P < .05). The MaxBraid and OrthoCord groups had higher failure loads than the suture anchor group (P < .05). The MaxBraid group also had a higher failure load than the Hi-Fi group (P < .05). Stiffness was not statistically different for the various tested constructs. After 100 cycles, the EndoButton group had less displacement than the FiberWire, UltraBraid, MaxBraid, and Hi-Fi groups (P < .05). The suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P < .05). The displacements of the different tested constructs between 100 and 500 cycles and total displacements after 500 cycles were not statistically different. The predominant failure mode was suture rupture. CONCLUSIONS: Under cyclic loading conditions in an ovine model, EndoButton fixation of tibial eminence fractures provided greater initial fixation strength than suture anchor fixation or fixation with various high-strength sutures except for OrthoCord. CLINICAL RELEVANCE: During initial cyclic loading of ACL tibial eminence fractures, the strength of the repair construct should be taken into consideration because conventional suture repair even with ultrahigh-molecular-weight polyethylene sutures may not provide enough strength. SN - 1526-3231 UR - https://www.unboundmedicine.com/medline/citation/22284410/Biomechanical_comparison_of_tibial_eminence_fracture_fixation_with_high_strength_suture_EndoButton_and_suture_anchor_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-8063(11)01262-X DB - PRIME DP - Unbound Medicine ER -