Background:Compaction of the bone-tunnel walls by serial dilation is believed to enhance the interference screw fixation strength of the soft tissue grafts in anterior cruciate ligament (ACL) reconstruction.
Hypothesis:Serial dilation enhances the fixation strength of soft tissue grafts in ACL reconstruction over extraction drilling.
Study Design:Randomized experimental study.
Methods:Initial fixation strength of the doubled anterior tibialis tendon grafts (fixed with a bioabsorbable interference screw) was assessed in 21 pairs of human cadaver tibiae with either serially dilated or extraction-drilled bone tunnels. The specimens were subjected to a cyclic-loading test, and those surviving were then tested using the single-cycle load-to-failure test.
Results:During the cyclic-loading test, there were 3 fixation failures in the serially dilated and 6 failures in the extraction-drilled specimens but no significant stiffness or displacement differences between the groups. In the subsequent load-to-failure test, the average yield loads were 473 ± 110 N and 480 ± 115 N for the 2 groups respectively (P= .97) and no difference with regard to stiffness or mode of failure.
Conclusions:Serial dilation does not increase the strength of interference fixation of soft tissue grafts in ACL reconstruction over extraction drilling.
Clinical Relevance:The results of this experiment do not support the use of serial dilators in ACL reconstruction.
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