Mechanical evaluation of a soft tissue interference screw with a small diameter: significance of graft/bone tunnel cross-sectional area ratio.

The purpose of this study is to evaluate the mechanical properties of a graft fixation using a small diameter soft tissue interference screw and analyze the factors affecting the fixation strength. Forty porcine knees were used. A bone tunnel, either 4.5 mm (n=40) or 5.0 mm (n=40) in diameter, was created in the bone block obtained from the proximal tibia or the distal femur. A patella-patellar tendon specimen with varied width was harvested, and the distal end of the patellar tendon was fixed within the bone tunnel using a small diameter soft tissue interference screw (4 x 15 mm). Then, the patella-patellar tendon-bone block complex was loaded until failure occurred and the maximum load was measured. As potential influential factors on the fixation strength, the insertion torque, bone mineral density of the bone block, and graft/tunnel cross-sectional area ratio (GTR) of each specimen were calculated. A significant correlation between the maximum failure load and the insertion torque was demonstrated. The quadratic regression analysis showed a statistically significant correlation between the failure load and the GTR. Optimal GTR for achieving high fixation strength was approximately 80%. When used in appropriate conditions, the mean failure load was 177 N for the 4.5 mm screw and 180 N for the 5 mm screw. The use of a small diameter interference screw for the fixation of a tendon graft to a bone is clinically feasible. Our research showed that the selection of appropriate fitting conditions is an important factor for optimizing the properties of the fixation.