gms | German Medical Science

54. Jahrestagung der Norddeutschen Orthopädenvereinigung e. V.

Norddeutsche Orthopädenvereinigung

16.06. bis 18.06.2005, Hamburg

17 months follow up after tibial fixation with a retrograde Interference screw technique in ACL-Replacement

Meeting Abstract

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Norddeutsche Orthopädenvereinigung. 54. Jahrestagung der Norddeutschen Orthopädenvereinigung e.V.. Hamburg, 16.-18.06.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05novK5.05

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Published: June 13, 2005

© 2005 Siekmann.
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In ACL-Replacement the intraosseous fixation of the hamstring graft with interference screws is getting more and more significant.

On the tibial side the screw usually is brought in from outside through the tibial drill hole. Only the tip of the screw is placed more or less near the bone surface.

Bringing in the tibial screw from inside similar to the femoral screw with the screw head flush to the bone there should be a complete avoidance of wind shield wiper - and the bungee effect.

Does the stability increase with this new technique when screwing the screw in the same direction the graft is pulled while fixing it?

Material and method

From 03/03 to 10/03 in 42 cases the tibial fixation was performed with an improvised retrograde screw technique. In 10/03 the special new tools and implants for this technique were launched in Europe and are generally available since that time.

The technique was performed with a resorbable biotenodesis-screw. These screws allow to push in a screw driver from the tip of the screw.

The screws were brought in retrograde from intraartikulär with the screw driver guided through the tibial tunnel.

The postoperative care was similar to the cases with the usual procedure. The ROM was not limited postoperatively. The patients had to do limited weight bearing with 15 kg for 2 weeks, then full weight bearing again. All patients got physiotherapy and continues passive motion postoperatively.


In November 2004 39 patients were investigated. The follow up was 17 month. The results were documented with the IKDC 2000 score.

Compared to the IKDC 2000 - results of an own former mid-term study the parameters like joint effusion, ROM, subjective assessment as a benchmark of knee function and especially ligament stability show better results.


The ACL-Replacement with ham strings is established, especially because of the less donor site morbidity and avoidance of wind shield wiper - and bungee effect.

Similar to the femoral fixation In consequence it was obvious to get the same fixation with the screw heads filling the tunnel orifice on the tibial side.

With this technique the screw head is located flush to the bone and fills the tibial tunnel defect completely. Any wind shield wiper effect is eliminated.

The pulling of the screwdriver follows the path of graft tension, the screwing itself again follows the path. Both effects tighten the graft.

This results in a better ligament-stability, documented with the IKDC 2000 score.