Evaluation of fixation methods in cruciate ligament replacement.

Laboratory studies designed to simulate in vivo loading of a ligament graft and fixation method are affected by the age of the cadaveric donor, the types of tissue and fixation device employed, and the testing methods used. The use of older donors compromises the graft bone, underlying bone bed, and soft tissue. Staples, sutures, and screws all provide different fixation strengths depending on the tissue to be held. Cyclic testing of the graft better evaluates the performance of the composite during the activities of daily living, while high-speed failure tests indicate the replacement's ability to resist a traumatic injury. Several studies were examined in light of these factors. Each study had certain merits but also limitations. Further studies are required for careful evaluation of the cyclic response of cancellous screws of different sizes, barbed staples, and other methods of graft fixation. Only then can recommendations be made as to the best device to use for achieving the clinical goals of joint stability, adequate resistance to traumatic loads, and proper graft attachment healing.