Biomechanical Comparison of the Bioabsorbable RetroScrew System, BioScrew XtraLok with Stress Equalization Tensioner, and 35-mm Delta Screws for Tibialis Anterior Graft-Tibial Tunnel Fixation in Porcine Tibiae

BACKGROUND: Achieving effective soft tissue graft-tibial tunnel fixation remains problematic. HYPOTHESIS: No differences would exist for tibialis anterior graft-tibial tunnel fixation when comparing the RetroScrew System (20-mm retrograde screw, 17-mm antegrade screw), the 35-mm tapered Delta Screw (manual tensioning), and the 35-mm BioScrew XtraLok (applied using an instrumented tensioner). STUDY DESIGN: Controlled laboratory study. METHODS: Porcine tibiae (apparent bone mineral density, 1.3 g/cm(2)) and human tendon allografts were divided into 3 matched groups of 6 specimens each before cyclic (500 cycles, 50-250 N, 1 Hz) and load-to-failure (20 mm/min) tests. RESULTS: The BioScrew XtraLok (210.9 +/- 54.9 N/mm) and the 35-mm Delta Screw (224.3 +/- 43.7 N/mm) displayed superior stiffness to the RetroScrew System (114.1 +/- 23.3 N/mm) (P = .0004) during cyclic testing. The BioScrew XtraLok (1.0 +/- 0.2 mm) and the Delta Screw (0.9 +/- 0.2 mm) also displayed less displacement during cyclic testing than the RetroScrew System (1.8 +/- 0.5 mm) (P = .001). During load-to-failure testing, the BioScrew XtraLok withstood greater loads (1436.3 +/- 331.3 N) (P = .001) and displayed greater stiffness (323.6 +/- 56.8 N/mm) (P = .002) than the 35-mm Delta Screw (load, 1042.2 +/- 214.4 N; stiffness, 257.2 +/- 22.2 N/mm) and the RetroScrew System (load, 778.7 +/- 177.5 N; stiffness, 204.4 +/- 52.9 N/mm). CONCLUSION: The BioScrew XtraLok with instrumented tensioning displayed superior fixation to the RetroScrew System and the 35-mm Delta Screw applied with manual tensioning. CLINICAL RELEVANCE: The BioScrew XtraLok may provide superior soft tissue graft-tibial tunnel fixation. Further in vitro studies using human tissue and in vivo clinical studies are needed.