• David W Starch, Jerry W Alexander, Philip C Noble, Suraj Reddy, and David M Lintner.
• Baylor Sports Medicine Institute, Barnhart Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas 78130, USA.
• Am J Sports Med. 2003 May 1; 31 (3): 338-44.

BackgroundTibial fixation of hamstring tendon grafts has been the weak link in anterior cruciate ligament reconstruction.HypothesisUse of a central four-quadrant sleeve and screw provides superior fixation when compared with standard interference screw fixation.Study DesignControlled laboratory study.MethodsIn eight pairs of cadaveric knees each anterior cruciate ligament was reconstructed using either an interference screw or a central sleeve and screw on the tibial side. The specimens were then subjected to cyclic loading followed by a load-to-failure test.ResultsThe load required to cause 1 and 2 mm of graft laxity, defined as the separation of the femur and the tibia at the points of graft fixation, was significantly greater with the sleeve and screw than with the interference screw (at 2 mm: sleeve and screw, 216.1 +/- 30.1 N; interference screw, 167.0 +/- 33.2 N). The force at initial slippage for each of the graft strands was significantly higher with use of the central sleeve and screw.ConclusionsThe four-quadrant sleeve and screw device may provide greater surface area for healing of hamstring tendon grafts and allow equal tensioning of graft strands before fixation. These factors are associated with increased strength of fixation and reduced laxity of the graft after cyclic loading.Clinical RelevanceUse of the central four-quadrant sleeve and screw system offers increased strength of fixation in anterior cruciate ligament reconstruction with hamstring tendon graft.

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