COMPARISON OF INSIDE-OUT AND OUTSIDE-IN INTERFERENCE SCREW FIXATION FOR ANTERIOR CRUCIATE LIGAMENT SURGERY IN A BOVINE KNEE

Despite numerous advances in graft fixation with anterior cruciate, li gament (ACL) reconstruction, few studies have compared the fixation st rength of interference screws placed ''outside-in'' and from ''inside- out'' techniques. To compare techniques, a bovine model was designed t o fail at the femoral tunnel bone-screw interface. Twenty-four fresh b ovine knees were stripped of all soft tissues except the ACL. The nati ve ACL was loaded the failure at a strain rate of 50 cm/min with the k nee flexed 45 degrees. One standardized femoral tunnel was created on all specimens. A 3/32-inch guide pin was drilled into the center of th e ACL femoral origin and overreamed with an Il-mm reamer from inside-o ut until the lateral cortex was reamed, Consistently sized patellar bo ne blocks were created (8 X 5 X 25 mm) with an 8-mm tendon width, The bone blocks were randomized to an ''inside-out'' (group 1) and ''outsi de-in'' (group 2) technique. Bone blocks were secured with a 7 X 25 in terference screw. Specimens were mounted with the femoral tunnel and b one block aligned parallel to the tensile force and strained to failur e at 50 cm/min. Failure of the native bovine ACL occurred at a mean of 2,304 N (SD +/- 472 N; n = 24). The mode of failure for group 1 was 9 of 13 at the bone-screw interface and 4 of 13 interligamentous failur es. The mode of failure for group 2 was 7 of 11 at the bone-screw inte rface, 3 of 11 interligamentous, and 1 bone block failure. The mean lo ad to failure for group 1 was 1,151 N (SD +/- 320 N, n = 13) including the-four ligamentous failures and 1,143 N (SD +/- 306 N, n = 9) exclu ding the ligamentous failures. The mean load to failure for group 2 wa s 1,017 N (SD +/- 262 N, n = 11), including all specimens and 843 N (S D +/- 262 N, n = 7) excluding the interligamentous and bone block fail ure specimens. The ''inside-out'' technique averaged 100 N greater fix ation strength than the ''outside-in'' technique. Statistical analysis using two-sample Student's t-test showed no statistically significant differences between group 1 and group 2. Both techniques demonstrate comparable maximum load to failure in a bovine model tested at 50 cm/m in.