{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T18:03:39Z","timestamp":1780941819521,"version":"3.54.1"},"reference-count":32,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2008,10,1]],"date-time":"2008-10-01T00:00:00Z","timestamp":1222819200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Effective soft tissue graft fixation to the tibial tunnel in all-inside anterior cruciate ligament reconstructions has been reported to be a problem and may lead to retrograde pullout at ultimate load testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Hypothesis<\/jats:title>\n                    <jats:p>A combined retrograde bioabsorbable screw and cortical-cancellous suture button suspension apparatus would gain stiffness from the button and strength from the screw, thus providing for a larger pullout ultimate load, yield load, and stiffness when compared with either fixation alone in an all-inside anterior cruciate ligament reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eighteen porcine tibias (average bone mineral density of 1.46, measured by dual-energy x-ray absorptiometry scan) and 18 bovine extensor tendon allografts were divided into 3 groups retrograde bioabsorbable screw fixation, cortical-cancellous suture button suspension apparatus fixation, and combined fixation in the tibia, with 6 specimens per group. They were biomechanically tested with cyclic (500 cycles, 50-250 N, 1 Hz) and load-to-failure (20 mm\/min) parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During cyclic testing, the retrograde screw\u2014only group had a larger cyclic displacement (2.98 \u00b1 2.28 mm) than the suture button with retrograde screw combination group (1.40 \u00b1 0.34 mm). The combination fixation group also produced a higher cyclic stiffness (161.93 \u00b1 61.81 N\/mm) than the retrograde screw\u2014only group (91.59 \u00b1 43.26 N\/mm). In load-to-failure testing, the retrograde screw with suture button combination group withstood significantly higher initial failure forces (873.87 \u00b1 148.74 N) than the retrograde screw\u2014only (558.44 \u00b1 126.33 N) and suture button\u2014only (121.76 \u00b1 40.57 N) groups. Additionally, ultimate loads were also significantly higher for the combination group (1027 \u00b1 157.11 N) than either the retrograde screw group (679.00 \u00b1 109.44 N) or the suture button group (161.00 \u00b1 29.27 N). The retrograde screw with suture button combination group showed significantly higher pullout stiffness (152.50 \u00b1 46.37 N\/mm) than either the retrograde screw\u2014only group (78.31 \u00b1 12.85 N\/mm) or the suture button\u2014only group (25.79 \u00b1 9.30 N\/mm).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Soft tissue grafts fixed with a combination of a retrograde screw and a suture button were able to withstand higher initial failure and ultimate failure loads and were also stiffer than grafts fixed with either a retrograde screw or a suture button alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>These findings may prove useful in providing additional stability when using an all-inside technique in a difficult case, or in a patient with poor bone stock, and may also be useful as an alternative to more commonly used tibial tunnel soft tissue fixation techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546508323747","type":"journal-article","created":{"date-parts":[[2008,10,1]],"date-time":"2008-10-01T22:13:12Z","timestamp":1222899192000},"page":"160-167","source":"Crossref","is-referenced-by-count":75,"title":["A Comparison between a Retrograde Interference Screw, Suture Button, and Combined Fixation on the Tibial Side in an All-Inside Anterior Cruciate Ligament Reconstruction"],"prefix":"10.1177","volume":"37","author":[{"given":"Michael P.","family":"Walsh","sequence":"first","affiliation":[{"name":"Division of Sports Medicine and the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coen A.","family":"Wijdicks","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine and the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josh B.","family":"Parker","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine and the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onur","family":"Hapa","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine and the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert F.","family":"LaPrade","sequence":"additional","affiliation":[{"name":"Division of Sports Medicine and the Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2008,10,1]]},"reference":[{"key":"bibr1-0363546508323747","doi-asserted-by":"publisher","DOI":"10.1177\/0363546503261714"},{"key":"bibr2-0363546508323747","doi-asserted-by":"publisher","DOI":"10.1007\/BF00369207"},{"key":"bibr3-0363546508323747","doi-asserted-by":"publisher","DOI":"10.1177\/03635465000280051501"},{"key":"bibr4-0363546508323747","doi-asserted-by":"publisher","DOI":"10.1177\/0363546504272265"},{"key":"bibr5-0363546508323747","doi-asserted-by":"publisher","DOI":"10.1053\/jars.2000.17983"},{"key":"bibr6-0363546508323747","doi-asserted-by":"publisher","DOI":"10.1115\/1.1351889"},{"key":"bibr7-0363546508323747","first-page":"11","volume":"178","author":"Fuss FK","year":"1991","journal-title":"J 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