Interference screw fixation of soft tissue grafts in anterior cruciate ligament reconstruction:: Part 1 -: Effect of tunnel compaction by serial dilators versus extraction drilling on the initial fixation strength

Background: Compaction of the bone-tunnel walls by serial dilation is believed to enhance the interference screw fixation strength of the soft tissue grafts in anterior cruciate ligament (ACL) reconstruction. Hypothesis: Serial dilation enhances the fixation strength of soft tissue grafts in ACL reconstruction over extraction drilling. Study Design: Randomized experimental study. Methods: Initial fixation strength of the doubled anterior tibialis tendon grafts (fixed with a bioabsorbable interference screw) was assessed in 21 pairs of human cadaver tibiae with either serially dilated or extraction-drilled bone tunnels. The specimens were subjected to a cyclic-loading test, and those surviving were then tested using the single-cycle load-to-failure test. Results: During the cyclic-loading test, there were 3 fixation failures in the serially dilated and 6 failures in the extraction-drilled specimens but no significant stiffness or displacement differences between the groups. In the subsequent load-to-failure test, the average yield loads were 473 +/- 110 N and 480 +/- 115 N for the 2 groups respectively (P = .97) and no difference with regard to stiffness or mode of failure. Conclusions: Serial dilation does not increase the strength of interference fixation of soft tissue grafts in ACL reconstruction over extraction drilling. Clinical Relevance: The results of this experiment do not support the use of serial dilators in ACL reconstruction.