Background: Fixation of an anterior cruciate ligament graft at the joint line with an interference screw restores anterior laxity better than low-stiffness distal fixation with double staples and sutures tied to a post at implantation in porcine bone.
Hypothesis: Fixation of an anterior cruciate ligament graft with a high-stiffness distal fixation device restores anterior laxity and knee stiffness as well as joint line fixation with an interference screw in human bone.
Study Design: Controlled laboratory study.
Methods: Eleven cadaveric knees with foam reinforcement of the bone were reconstructed with a double-looped tendon graft and fixed with an interference screw and 3 high-stiffness methods of fixation (tandem washer, WasherLoc, and WasherLoc with bone dowel). Anterior laxity at 225 and 110 N of anterior load and knee stiffness were measured at 0°, 30°, 60°, 90°, and 120° of flexion with a 6 degrees of freedom load application system.
Results: The increase in anterior laxity and knee stiffness with the interference screw was not significantly different from that with the high-stiffness distal methods.
Conclusion: In the human knee, the use of high-stiffness fixation devices placed distal to the joint line restored anterior laxity and knee stiffness as well as joint line fixation with an interference screw at implantation.
Clinical Relevance: The stiffness provided by each method of fixation should be considered along with the length of the graft when determining anterior laxity and knee stiffness.
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