Novel Femoral Fixation Of Quadrupled ACL Reconstruction Graft Using Cancellous Bracing. Biomechanical Comparison With Established Devices

INTRODUCTION. The anterior cruciate ligament (ACL) is the most commonly injured major ligament of the knee (1). There are over 300,000 annually reported ACL injuries, a majority of which are complete ruptures (2). Long term success rates of 69-90% have been reported after arthrosopically-assisted ACL reconstruction, with a majority of failures related to graft fixation and surgical error. The emerging standard for graft tissue is the quadrupled hamstring tendon graft. This has spurred the development of more specialized fixation devices that allow for a stronger biomechanical construct. Optimal initial fixation is important in rehabilitation as the strength of fixation, rather than the strength of the graft, has been noted to be the weakest link in primary stability (3). The aim of this study was to compare the biomechanical strength of current femoral fixation devices, including a new single-hole, unicortical device designed to gain purchase by laterally engaging the cancellous bone. Recent findings suggest greatest construct strength and stiffness is obtained with a transversely fixed, over-the-top graft (4), although this two-hole technique may introduce higher morbidity risk.