Biomedical subjects

Jens Dargel

Publications and source records attributed to Jens Dargel.

4 recordsLinked to original sources

PubMed2006

The effect of bone tunnel dilation versus extraction drilling on the initial fixation strength of press-fit anterior cruciate ligament reconstruction.

INTRODUCTION: Serial dilation of the bone tunnel has been reported to create a tighter graft-tunnel fit. It was hypothesized that a serial dilation of the femoral bone tunnel would increase the initial fixation strength in press-fit anterior cruciate ligament (ACL) reconstructive surgery. MATERIALS AND METHODS: Initial fixation strength of the femoral press-fit fixation technique was investigated in 72 porcine specimens in an ex vivo study by varying the femoral tunnel preparation technique. Extraction-drilling, tunnel dilation by 1 mm and dilation by 2.5 mm were assessed. Initial fixation strength of press-fit fixated patellar tendon-bone grafts was tested within each preparation group conducting a single cycle (and cyclic) load to failure protocol. The resulting tunnel diameter and the porcine femoral bone mineral density were determined using microradiographs and peripheral quantitative CT scans, respectively. RESULTS: Dilating a previously extraction-drilled femoral bone tunnel by 1 mm significantly enhances initial press-fit fixation strength in both single cycle and cyclic load to failure testing when compared to extraction-drilling and tunnel dilation by 2.5 mm. Due to an initial spring-back effect the resulting diameter of the femoral tunnel was underestimated by 3.3% with drilling and 6.7 and 12.2% with dilation by 1 and 2.5 mm, respectively. Volumetric trabecular bone mineral density at the site corresponding to the area of tunnel placement averaged 318 mg/cm(3). CONCLUSION: Dilating a femoral tunnel that is underdrilled by 1 mm appears to be a reasonable technical procedure in order to enhance initial fixation strength of press-fit ACL graft fixation.

Analysis of Variance↗

PubMed2006

Morphometric side-to-side differences in human cruciate ligament insertions.

Graft placement in cruciate ligament reconstruction is known to significantly influence postoperative knee stability and range of motion. Improvement of bone tunnel positioning has been advocated by computer-assisted surgical procedures that require reliable input and reference data. This study validates the hypothesis that morphometric reference data can be obtained from the uninjured controlateral knee for accurate bone tunnel and graft positioning. Thirty pairs of human cadaver knees were dissected and the femoral and tibial footprints of the anterior and posterior cruciate ligaments (PCL) were radiopaquely marked. Radiographs were taken of the corresponding left- and right-sided femora and tibiae, and digitally processed. Controlateral specimens were mirrored and overlapped precisely, the areas and intersections of ligament insertion were digitally determined. There were no significant differences in the total area of cruciate ligament insertion between left and right knee specimens or between female and male specimens. Intersection areas (IAs) in femoral and tibial anterior cruciate ligament (ACL) insertions averaged 31.3 and 33.4% of the total insertion area, respectively. The center of gravity for the femoral and tibial ACL footprint differed by 4.7 and 4.5 mm between left and right knees, respectively. IAs in femoral and tibial PCL insertions averaged 46.1 and 61.3% of the total insertion area, respectively. The center of gravity for the femoral and tibial PCL footprint differed by 4.5 and 2.4 mm between left and right knees, respectively. Our study does not support the concept of obtaining morphologic reference data from the uninjured controlateral knee for individual bone tunnel placement.

Aged↗

PubMed2005

Biomechanical testing of quadriceps tendon-patellar bone grafts: an alternative graft source for press-fit anterior cruciate ligament reconstruction?

INTRODUCTION: Press-fit fixation of bone-patellar tendon-bone (BPTB) grafts in anterior cruciate ligament (ACL) reconstruction has been analyzed biomechanically in previous studies; however, the use of quadriceps tendon-patellar bone (QTPB) grafts has not been studied so far. It is hypothesized that QTPB grafts provide primary fixation strength comparable to BPTB grafts in press-fit ACL reconstruction with respect to bone plug length and loading angle. MATERIALS AND METHODS: Fifty-two QTPB grafts were harvested from fresh human cadaver knees (mean age 73.3 years) with the length of the patellar bone plug being either 15 mm (Group I) or 25 mm (Group II). The grafts were anchored within fresh porcine femora (mean age 12 months) using a press-fit fixation technique. Forty-eight specimens were loaded to failure at 10 mm/s with varying loading angles of 0 degrees , 30 degrees , and 60 degrees until failure. A microradiographic pre-post-implantation analysis was conducted on four grafts. RESULTS: The biomechanical testing showed a significant difference in the ultimate failure loads comparing Group I (mean 224+/-79.3 N) to Group II (mean 339+/-61.4 N), both showing mean ultimate failure loads to increase with rising loading angle. The predominant mode of failure was graft pullout at axial loading and tendon rupture at 60 degrees loading angle. The microradiographic analysis revealed an iatrogenic damage of the bone-tendon junction on the cancellous aspect of the bone plug in all trials, corresponding with the site of impactor placement during implantation. CONCLUSION: QTPB grafts provide a loading capability comparable to BPTB grafts in press-fit ACL reconstruction. The broad and profound area of quadriceps tendon attachment to the patellar bone plug makes graft implantation demanding.

Aged↗

PubMed2005

Histomorphology and microradiography of quadriceps tendon-patellar bone grafts in press-fit anterior cruciate ligament reconstruction.

The press-fit fixation technique has become an alternative fixation method in anterior cruciate ligament (ACL) reconstruction. While the stability of press-fit fixated grafts reported in the literature predominantly had been analysed by biomechanical testing, this study investigated the specific histomorphologic and microradiographic features important for graft stability, using human quadriceps tendon-patellar bone (QTPB) grafts. Six QTPB grafts with cylindrical bone plugs were obtained from frozen fresh human cadaver knees and fixed to porcine, bovine, or human femora in a press-fit technique. The specimens were plastinated, dissected into 1.5 mm slices, studied microradiographically and stained for histologic evaluation. The specimens showed an osseous inclusion of the graft within the femoral tunnel, which was most evident on the cancellous side. Histologic analysis revealed a trabecular interdigitation with a penetration of patellar and femoral trabecular structures, contributing to primary stability of the press-fit fixation. Graft inclusion was most obvious in bovine and least in human femora, assumably because of varying bone quality. The circular bone-to-bone contact in press-fit fixation technique should contribute to both rapid and stable graft healing.

Animals↗