Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2021 Mar 25

PMID 33763498

Citations 6

Authors

Heath P Gould

Nicholas R Delaney

Brent G Parks

Roshan T Melvani

Richard Y Hinton

Affiliations

Soon will be listed here.

Abstract

Background: Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation.

Purpose: To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction.

Study Design: Controlled laboratory study.

Methods: Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired test was used to compare the mean load to failure and the mean stiffness between groups.

Results: No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout.

Conclusion: In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL.

Clinical Relevance: These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.

Citing Articles

All-Suture Anchor Onlay Fixation for Medial Patellofemoral Ligament Reconstruction: A Biomechanical Comparison of Fixation Constructs.

Smith B, Bedi A, Hauck O, Wijdicks C, Riboh J Orthop J Sports Med. 2024; 12(11):23259671241294011.

PMID: 39583149 PMC: 11585034. DOI: 10.1177/23259671241294011.

What is the best fixation method in medial patellofemoral ligament reconstruction? A biomechanical comparison of common methods for femoral graft attachment.

Vezole L, Gunst S, Gras L, Shatrov J, Mertbakan O, Lustig S SICOT J. 2024; 10:7.

PMID: 38334592 PMC: 10854485. DOI: 10.1051/sicotj/2024004.

No Difference in Pullout Strength Between a Bio-inductive Implant and a Semitendinosus Tendon Graft in a Biomechanical Study of Medial Patellofemoral Ligament Repair Augmentation.

Wetzler A, McMillan S, Brewer E, Patel A, Handy S, Wetzler M Arthrosc Sports Med Rehabil. 2024; 6(1):100827.

PMID: 38313861 PMC: 10834473. DOI: 10.1016/j.asmr.2023.100827.

The Adductor Sling Technique for Pediatric Medial Patellofemoral Ligament Reconstruction Better Resists Dislocation Loads When Compared With Adductor Transfer at Time Zero in a Cadaveric Model.

Balazs G, Meyers K, Dennis E, Maher S, Shubin Stein B Arthrosc Sports Med Rehabil. 2024; 6(1):100831.

PMID: 38169763 PMC: 10758716. DOI: 10.1016/j.asmr.2023.100831.

Interference Screws Are Biomechanically Superior to Suture Anchors for Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-Analysis.

Sequeira S, Imbergamo C, Gould H Arthrosc Sports Med Rehabil. 2022; 4(4):e1581-e1588.

PMID: 36033175 PMC: 9402472. DOI: 10.1016/j.asmr.2022.05.003.

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