Femoral fixation strength following soft-tissue posterolateral corner reconstruction using fibular-based technique: Biomechanical analysis of four techniques in normal and low-density synthetic bone

• We tested 4 femoral fixation techniques for soft-tissue in posterolateral corner reconstructions.
• No method produced significantly stronger yield load or peak load-to-failure in normal bone.
• Load-to-failure was higher in normal-density bone with spiked washer or interference screw fixation.
• In low-density bone, cortically-based methods produced significantly higher peak load-to-failure.
• Most fixation methods are acceptable in normal bone; cortical methods are better in low-density.

BackgroundOptimal femoral fixation of soft-tissue grafts has been described for anterior cruciate ligament reconstruction. Posterolateral corner reconstruction differs from ACL reconstruction in two ways: (a) soft-tissue fixation into the femur requires two tails and (b) the line of force is different. Our purpose was to determine the optimal femoral fixation of soft-tissue grafts during posterolateral corner reconstructions. We hypothesized that interference screw fixation is the strongest technique in normal-density lateral femoral condyle, whereas, cortically-based fixation techniques are stronger methods in low-density lateral femoral condyle.MethodsWe evaluated elongation during cyclic loading, yield load, peak load-to-failure, and stiffness of four soft-tissue graft femoral fixation methods during posterolateral corner reconstruction. Our model included bovine flexor tendons and contoured synthetic bones. Grafts were secured to the lateral epicondyle in normal- or low-density bone models using spiked washer, button, interference screw, or button and interference screw. Five specimens for each were tested in each bone density. Analysis of variance using Tukey–Kramer adjustment for multiple hypothesis testing was used. Six cadaver bones whose density was analyzed using computerized tomography scan quantitation were tested using interference screw fixation.ResultsNo method produced significantly stronger yield load or peak load-to-failure in normal-density bone. In low-density bone, cortically-based methods produced significantly higher yield load or peak load-to-failure. Yield load or peak load-to-failure was significantly higher in normal-density bone when using spiked washer or interference screw fixation.ConclusionNo femoral fixation method tested produced superior yield load or peak load-to-failure. Spiked washer and interference screw fixation are inferior fixation methods in low-density bone.Clinical relevanceFor fibular-based posterolateral corner reconstructions, all fixation methods tested are acceptable in high-density bone, while cortical fixation methods should be considered in low-density bone.