The most important consideration in ACL reconstruction is that the tunnels are put in the correct position. After this, the fixation of the graft is the next most important factor in a satisfactory clinical outcome. The physician should become proficient at one of these techniques. For revi-
Table 5.2. Ultimate load to failure of tibial fixation devices.
Single staple Double staple Screw post Button RCI
BioScrew and button Intrafix
Screw and washer Washer Loc
100N 500N 600N 400N 300N 400N 600N 700N 800N 900N
sions, physicians may need to have available another type of fixation to deal with hardware and tunnel expansion.
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