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A Biomechanical Evaluation of Transcondylar Femoral Fixation of Anterior Cruciate Ligament Grafts

Gianluca Camillieri, MD^*, Edward G. McFarland, MD^,, Louis E. Jasper, BSME, Stephen M. Belkoff, PhD, Tae Kyun Kim, MD, PhD, Peter B. Rauh, MD and Pier Paolo Mariani, MD^*

From the ^* Department of Sports Traumatology, University for Motor Sciences, Rome, Italy, and the Division of Sports Medicine and Shoulder Surgery and Orthopaedic Bioinstrumentation Laboratory, Department of Orthopaedic Surgery, Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, Maryland

Address correspondence to Edward G. McFarland, MD, c/o Elaine P. Henze, Medical Editor, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Room #A672, Baltimore, MD 21224-2780 (e-mail: ehenze1{at}jhmi.edu).

Background: Interference screw fixation of the graft in anterior cruciate ligament reconstruction is considered the gold standard, but limited clinical experience suggests that transcondylar fixation is equally effective.

Purpose: To compare transcondylar and interference screw fixation.

Study Design: Ex vivo biomechanical study.

Methods: Twenty pairs of unembalmed knees underwent anterior cruciate ligament reconstruction with patellar tendon autografts. In 1 knee of each pair, the bone plug was stabilized in the femoral tunnel with standard interference screws; in the other knee, transcondylar screws were used. Testing to failure occurred immediately or after 1000 cycles of sinusoidal loading (30 to 150 N) (20 paired reconstructions each). Fixation stiffness, strength, graft creep, displacement amplitude, and change in amplitude were measured and compared (repeated measures anaylsis of variance with Tukey test; P < .05).

Results: There was no significant difference in acute strength, maximum load within 3 mm, or stiffness between transcondylar fixation (410 ± 164 N, 183 ± 93 N, and 49.6 ± 28 N/mm, respectively) and interference fixation (497 ± 216 N, 206 ± 115 N, and 61 ± 37.8 N/mm, respectively). Similarly, there was no significant difference in cyclic strength, maximum load within 3 mm, or stiffness between transcondylar fixation (496 ± 214 N, 357 ± 82.9 N, and 110 ± 27.4 N/mm, respectively) and interference fixation (552 ± 233 N, 357 ± 76.2 N, and 112 ± 26.8 N/mm, respectively). Predominant modes of failure were bone plug pullout (transcondylar fixation) and tendon failure or bone plug fracture (interference fixation).

Conclusions: Transcondylar screw fixation of the patellar tendon autograft into the femoral tunnel performed mechanically as well as interference screw fixation.

Clinical Relevance: The results suggest that transcondylar and interference screws provide similar fixation for anterior cruciate ligament reconstruction.

Key Words: anterior cruciate ligament (ACL) reconstruction • femoral tunnel fixation • autograft • interference screw • transcondylar screw