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Serial dilation versus extraction drilling in anterior cruciate ligament reconstruction: a biomechanical study

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Abstract

The hamstring tendon graft has become increasingly popular in anterior cruciate ligament reconstruction because of low donor-site morbidity. However, the tibial fixation is considered difficult, mainly because of low tibial mineral bone density. Therefore, we tested whether preparation of the tibial tunnel with compaction by serial dilation provided a stronger anchorage of the graft–fixation-device complex than does traditional extraction drilling of the tibial tunnel. In 20 bovine tibiae, the bone tunnels were created with either extraction drilling (group 1) or compaction by serial dilation (group 2). Twenty bovine digital extensor tendons were fixated in the bone tunnel with an Intrafix tibial fastener. The graft–fixation-device complexes were mounted in a hydraulic test machine. The fixation strength was evaluated after cyclic loading. The difference between the serial dilation group and the extraction drilling group ranged from a mean slippage of 0 mm at 70–220 N, to a mean slippage of 0.1 mm at 70–520 N. We found no significant difference in slippage of the graft–fixation-device complex after 1,600 cycles. This study failed to show a significant difference between compaction by serial dilation and extraction drilling of the tibia bone tunnel in anterior cruciate ligament reconstruction.

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Acknowledgments

The authors would like to thank protesekompagniet, Denmark for providing the fixation devices; Smith and Nephew for the instruments and Johnson and Johnson for the suture material.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Author information

Correspondence to O. G. Sørensen.

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Sørensen, O.G., Jakobsen, B.W., Kold, S. et al. Serial dilation versus extraction drilling in anterior cruciate ligament reconstruction: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 18, 742–746 (2010). https://doi.org/10.1007/s00167-009-0922-x

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Keywords

  • Anterior cruciate ligament
  • Compaction
  • Serial dilation
  • Extraction drilling
  • ACL
  • Fixation strength