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Purpose: The aim of the present study was to compare primary stability in ACL reconstruction and ultimate load to failure of a mesh augmented hamstring tendon graft fixed with two cross pins to established hamstrings and bone-patellar-tendon-bone (BTB) graft fixation methods., Methods: Forty fresh porcine femora were divided into four groups: (A): BTB graft fixed with two RigidFix® pins, (B): hamstring tendon graft fixed with a Milagro® interference screw, (C): hamstring tendon graft fixed with two RigidFix® pins, and (D): hamstring tendon graft augmented with Ultrapro® mesh fixed with two RigidFix® pins. Each graft underwent cyclic loading in tension and load to failure. Elastic and plastic displacements were measured by 3-dimensional digital image correlation. Groups were compared by one-way ANOVA and Tukey-Kramer post-hoc tests., Results: After 1000 cycles, the mean plastic displacement was lowest in the BTB graft (p < 0.001). Plastic displacement was significantly lower in the mesh augmented group compared to the plain hamstring graft and the Milagro screw group (p < 0.05). Load to failure was highest in the mesh-augmented group; significant to the hamstring tendon (p = 0.023)., Conclusion: Although the BTB-graft represented the most stable construct against plastic displacement in our study, mesh augmentation of free tendon grafts significantly increased primary stability and reduced plastic displacement of femoral cross pin fixation. This new augmentation device may better protect the hamstrings graft from secondary elongation during postoperative rehabilitation., Clinical Relevance: Mesh augmentation seems to be an effective technique to stabilise free hamstring tendon autografts during postoperative rehabilitation with significant reduction of graft slippage., (Copyright © 2012 Elsevier B.V. All rights reserved.)

This is a comparative in vitro biomechanical study of the primary stability of an anterior lumbar interbody stabilization. The objective was to compare the stability of a interbody stabilizing titanium cage with and without the retention of the bordering vertebral endplates, as well as to compare the titanium cage with a tricalcium phosphate block when the endplates are removed. An adequate blood supply is critical for interbody fusion, which suggests surgical treatment of the bordering endplates. On the other hand, primary stability is improved by the retention of the endplates. Furthermore, bone substitute materials are finding more frequent use due to complications associated with autologous bone grafts. Ten bovine lumbar spine motion segments (average age 6 months) were investigated. Pure bending loadings as well as eccentric axial compression loadings were applied. A titanium cage and tricalcium phosphate block, were tested in conjunction with an anterior augmentation (MACS). Range of motion, neutral zone (NZ) and bending stiffness were measured under pure bending to 10 Nm, and bending stiffness under axial loads of up to 1,500 N. Range of motion of both implants in flexion-extension was significantly smaller than physiologic (cage without endplates 4.3 degrees , cage with 2.8 degrees , block without 3.4 degrees , and physiologic 6.6 degrees , all p<0.001). The cage with endplates and the block without endplates were both significantly stiffer than physiologic in all directions except left lateral bending. The block without endplates and the cage with endplates were both stiffer than the cage without endplates. The results suggest that the use of the bone substitute block provides better stability than the cage when the endplates are removed.

Study Design: This is a comparative in vitro biomechanical study in a calf lumbar spine model., Objectives: The objective was to compare the primary stability of an anterior instrumentation, an intercorporal cage in combination with an anterior instrumentation, and a posterior instrumentation for monosegmental spondylodesis., Summary of Background Data: Spondylodesis can be achieved through a posterior lumbar fusion, posterior lumbar intercorporal fusion, or an anterior lumbar intercorporal fusion. The posterior lumbar fusion is the gold standard, although the anterior approach offers some potential advantages to the transpedicular posterior techniques., Methods: Stability testing was performed on 30 calf lumbar spine motion segments in a physiologic state (n = 30), with either an isolated anterior (MACS) or posterior instrumentation (SOCON), and with an anterior instrumentation augmented with an intercorporal cage (MACS-Cage, n = 10, respectively). Range of motion, neutral zone, and bending stiffness were measured under pure bending to 10 Nm, and bending stiffness under axial loads of up to 1500 N., Results: The isolated posterior instrumentation was found to be more stable than the isolated or augmented anterior instrumentation in flexion/extension, although no significant differences were observed in lateral bending or axial rotation. The results of this biomechanical study suggest that an augmented anterior instrumentation provides similar stability for bony fusion as does the golden standard posterior instrumentation, with the exception of flexion/extension., Conclusion: An augmented anterior instrumentation may provide similar stability for bony fusion as does the posterior instrumentation.

Aim: The primary stability of ventral fixation systems has been improved over the past years and special implants supporting minimally invasive procedures have been developed. The aim of this study was to analyze the primary stability of several of these implants., Methods: Thirty (30) lumbar segments from 5 to 7-month-old calves were harvested and tested on a pure moment apparatus (PMA) as well as a modified materials testing machine (MTS) according to the European standard recommendations of Wilke et al. Three different implant systems (MACS, Centaur and Z-plate) were included. ROM, neutral zone and stiffness were tested on the PMA up to 10 Nm, stiffness at an eccentric axial load of up to 1500 N was tested on the MTS. Bone density was investigated for all specimens. Statistical analysis was performed by ANOVA and LSD tests., Results: Primary stability was improved by all fixation devices compared to the physiological specimen. The MACS implant was more stable than the Centaur and Z-plate with the exception of in lateral bending [where the Z-plate was stiffer]. Bone density was comparable in the three different experimental groups., Conclusion: Minimal invasive ventral fixation devices are becoming popular. The primary stability of the minimal invasive MACS was comparable to those of other well-known ventral fixation devices of the lumbar spine.