The Effect of Kurosaka Screw Divergence on the Holding Strength of Bone-Tendon-Bone Grafts

Fresh-frozen porcine knees were used to demonstrate the effects of diverging Kurosaka screw placement on linear load to failure in simulated anterior cruciate liga ment reconstructions. Screws, placed anteromedially (rear-entry or tibial type) or intraarticularly (endoscopic femoral type) into each...

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Bibliographic Details
Published in:The American journal of sports medicine 1995-05, Vol.23 (3), p.332-335
Main Authors: Pierz, Kristan, Baltz, Matthew, Fulkerson, John
Format: Article
Language:English
Subjects:
Animals
Anterior cruciate ligament
Anterior Cruciate Ligament - surgery
Arthroscopes
Biological and medical sciences
Biomechanical Phenomena
Bone Screws
Bone transplantation
Bone-grafting
Evaluation
Femur - surgery
Knee
Ligaments
Medical sciences
Orthopedic surgery
Sports medicine
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Swine
Tendon Transfer - instrumentation
Tendon transplantation
Tendons
Tibia - surgery
Transplantation
Treatment Failure
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Summary:Fresh-frozen porcine knees were used to demonstrate the effects of diverging Kurosaka screw placement on linear load to failure in simulated anterior cruciate liga ment reconstructions. Screws, placed anteromedially (rear-entry or tibial type) or intraarticularly (endoscopic femoral type) into each tibia, were directed at 0°, 15°, or 30° divergence angles relative to a guide wire. Grafts were axially loaded to failure to determine holding strength. Hierarchical analysis of variance was used to analyze differences between tibial side and endoscopic femoral type screw placement and the angles of diver gence. Overall, the difference in pullout strength be tween rear-entry (or tibial side) and endoscopic femoral type fixation was shown to be statistically significant (P < 0.001). Anteromedially placed screws showed a sta tistically significant decrease in holding strength at 15° and 30° compared with 0° of divergence (P < 0.05). Intraarticular screw placement resulted in a statistically significant decrease in holding strength only at 30° of divergence (P < 0.05). This study supports the impor tance of accurate screw placement within the tibia to ensure optimal interference fixation and suggests that endoscopic screw placement may offer significant added security when there are minor degrees of divergence.
ISSN:0363-5465
1552-3365
DOI:10.1177/036354659502300314