ACL Attachment

Replacing Conventional Interference Screws with a Clamp in Anterior Cruciate Ligament (ACL) Reconstruction to Increase the Creep Resistance of Synthetic Ligaments

March 11, 2011 Meagan Higgins Amy Lautenbach Stacy Patch Alex Stanley

Outline

Background: Current Technology Material Science and Mechanics Proposed Solution Test Methods and Procedure Results Discussion Recommendations

Background: Current Technology

Most frequently studied limb in orthopaedic research ACL provides stability and function of the knee 3 types of ACL Reconstructions Autografts Allografts Synthetic

Background: Current Technology

Interference screws Endo-button and spiked washer (Smith & Nephew) Femoral cross pins

Material Science and Mechanics

Ligaments under physiologic loading exhibit nonlinear, viscoelastic behavior Further loading recruits more ligament fiber bundles

Viscoelastic Polymers When subjected to applied stress, entropy decreases (less disordered) permanent elongation due to unwinding of the polymer chains

Material Science and Mechanics

Stress relaxation is directly related to strain Stress Relaxation in ACL grafts reduces graft forces from the initial level set at surgery

Creep represents the non-linear increase in deformation over time when the stress is constant or subjected to cyclically repetitive stress

Non-linear viscoelasticity indicates time dependent mechanical behavior Principles relate creep and stress relaxation of biological materials

Material Science and Mechanics

Hysteresis: Energy dissipation

When a viscoelastic material is loaded and unloaded, the unloading curve will not follow the loading curve The difference between the two curves => amount of energy that is dissipated

Material Science and Mechanics

Kevlar (Aramid Fiber) 464 363 Carbon Fiber 348 319

Tensile Strength (KSI) Flexural Strength (KSI) Elongation (% Strain)

1-1.3%

1.8-2%

Problem Statement/ Proposed Solution

Problem Statement: The elongation due to creep found in synthetic ACLs prevents the ligament from providing sufficient long-term stability and makes the ligament more likely to fail. Proposed Solution: If we use an attachment that better distributes the force exerted by the body onto the ligament across the entire area of the ligament, there will be less stress and wear on certain fibers which will make it able to last longer.

Proposed Solution

Screw

Proposed:

Current :

Clamp

Test Method/Procedure

Perform a stress relaxation test on silicone samples embedded with Kevlar or Carbon fiber braids DoE: 2 Factors, 2 Levels

Factors: Attachment method, Fiber Material Levels: Clamp/screw, Kevlar/carbon fiber

Performing the Test

Graphing the Results

1. Kevlar; Clamp 2. Kevlar; Screw 3. Carbon Fiber; Screw 4. Carbon Fiber; Clamp

More Graphs

1. Carbon Fiber; Clamp 2. Carbon Fiber; Screw 3. Kevlar; Clamp 4. Kevlar; Screw

Discussion/Conclusions

Unable to calculate stress relaxation Observations show clamp holds higher loads for more time No consistency of kevlar versus carbon fiber

Recommendations and Future Directions

Different strain More consistent measurements of silicone

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