Anterior Cruciate Ligament Graft Fixation

The initial biomechanical properties of semitendinosus and patellar tendon autografts and their fixation strengths were investigated. Twenty fresh cadaveric knees from donors under 42 years of age were used in the study. After removing all soft tissues other than the anterior cruciate ligament, we determined the ultimate tensile strength (2195 ± 427 N) and stiffness (306 ± 80 N/mm) of the anterior cruciate ligament in nine knees. In six knees, anterior cruciate ligaments were reconstructed using an autologous patellar tendon graft with proximal and distal interference fit screws; this resulted in an ultimate tensile strength of 416 ± 66 N. Five knees were reconstructed with quadruple- stranded (double-looped) semitendinosus tendons fixed proximally by a titanium button and braided tape and distally by tibial post screw. This resulted in an ultimate tensile strength of 612 ± 73 N, which was significantly higher than the strength in the patellar tendon group. Graft stiffness did not differ between the groups and was 47 ± 19 N/mm (N = 11). This study demonstrates that the reconstructed knees had only 20% to 30% of the ultimate tensile strength of the normal anterior cruciate ligament. In summary, the semitendinosus reconstruction using a button for prox imal fixation is, at the time of surgery, approximately 50% stronger than patellar tendon reconstructions with similar stiffness.