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Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 363 - 363
1 Jul 2011
Kalambokis A Kokoroghiannis C Deligeorgis A Magnissalis E Aktselis I Karagiannis S
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Locking strategies of the sliding screw in gamma nailing (G3) were tested in an experimental biomechanical study.

Twelve Composite Femoral Bone models were used. An intertrochanteric osteotomy was performed and a gamma nail was implanted in each specimen. The specimens were divided in 3 groups:

compressed and locked,

locked at distance and

unlocked. Each specimen was subjected to 4 cycles of static vertical loading of up to 1100 Newtons (N) at a rate of 10 mm/minute.

Subsequently, the specimens were investigated for cut-out patterns using digital photography and management.

All failures occurred under supraphysiological loads. During their first loading cycles, no statistical differences for stiffness and yield load were noted. Nevertheless, there was a non–significant tendency for higher failure loads for the unlocked group. Under maximum load (1100 N) and already established deformations, all Gamma Nails behaved similarly in terms of neck-screw displacement, with no statistical differences.

Unlocked screws exhibited the most moderate failure modes followed by the compressed and locked group. The third group showed the most severe failures.

In conclusion, there is evidence that sliding is biomechanically superior in gamma nailing. Despite adverse mechanical circumstances all specimens behaved satisfactorily under physiological loading


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 614 - 614
1 Oct 2010
Bisbinas I Beslikas T Christoforidis I Hatzokos I Magnissalis E Vavaletskos S
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Purpose: The purpose of our work was to assess sutures, suturing techniques, and suture anchors used in rotator cuff surgery in order to explore weak parts in our repair.

Material and Methods: Ten types of sutures, four types of suturing techniques and eight types of sutures anchors commonly used in shoulder surgery were tested. Vicryl, Ticron, Dexon, PDS, Panacryl, Ethibond, Durabraid, Fiberwire, HiFi and Orthocord sutures were tested. Simple, mattress, massive cuff tear (MCT) technique and modified Mason Allen.

(MMA) suturing technique in ex-vivo ovine healthy rotator cuff were tested. Four metallic and four bioabsorbable anchors: Arthrex, Smith+Nephew, Linvatec, Mitek and bio respectively were tested. Their pull-out strength and failure mode was determined in ex-vivo ovine humeral heads. Materials Testing Machine and attached load cell run with Emperor Software (MEC-MESIN, UK) was used for the tests with application of tensile load(60mm/min). Load and displacement were recorded at a sampling rate of 100 Hz and breaking load and stiffness were recorded.

Results: The suture mean breaking strength (N) was: Vicryl 89.0, Ticron 70.9, Dexon 111.7, PDS 92.9, Panacryl 52.9, Ethibond 64.5, Durabraid 72.6, Fiber-wire 127.2, HiFi 163.0 and Orthocord 141.8. The mean suture stiffness (N/mm) was: Vicryl 3.4, Ticron 3.0, Dexon 2.4, PDS 1.2, Panacryl 0.7, Ethibond 2.5, Durabraid 3.1, Fiberwire 9.7, HiFi 11.1, and Orthocord 6.9. The technique’s mean breaking strength (N) was: simple 54.1, mattress 102.8, MCT 194.0, MMA 227.7 and their mean stiffness (N/mm) was: simple 10.4, mattress 13.1, MCT 26.0 and MMA 18.9. The anchors had mean pull-out strength (N): Arthrex 534.0 and Smith & Nephew 574.0, Linvatec 707.2N, Mitek 736.4N and Arthrex Bio 257.4, Linvatec Bio 305.2, Mitek Bio 359.6, S& N Bio 330.6. Often either in metallic (10/20) or in bioabsorbable anchors (11/20) the eyelet fails first.

Conclusion: Modern non absorbable sutures (HiFi Orthocord Fiberwire) have higher breaking strength and stiffness than absorbable ones (p< 0.05). MCT suturing technique, arthroscopically applicable, and MMA technique, which is most commonly used in open surgery have no great differences in strength and stiffness (p=0.046 and p=0.352 respectively). Both of them have higher strength and stiffness than simple and mattress technique (p< 0.05). Metallic anchors have a higher pull-out strength than bioabsorbable ones (p< 0.05) and the eyelet is a weak point in both.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 233 - 233
1 Mar 2004
Sourlas J Papachristou G Magnissalis E Efstathopoulos N Plessas S
Full Access

Aims: The topographical measurement and representation of the ACL insertion on the tibial plateau, based on a greek population sample. Methods: Fourty eight tibial plateaus were explanted during TKA surgery in 33 female and 15 male patients (average age of 71.2 yrs) suffering from osteoarthritis and rheumatoid arthritis. By means of a calliper, measurements were conducted in order to determine the dimensions shown. Data were used for a topographical representation.

Conclusions: To the authors’ best knowledge, this is the first such anthropometric study on a greek population and its results provide a confirmation on the relatively wide base of ACL insertion on the tibial plateau. The biomechanical performance of this natural configuration for a full range of motion, is possibly not sufficiently reproduced by conventional ACL reconstruction techniques using just one bundle.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 175 - 175
1 Feb 2004
Papachristou G Sourlas J Magnissalis E Efstathopoulos N Plessas S
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Aims: The experimental application and biomechanical evaluation of a double – bundle ACL reconstructive technique(Ä plasty)

Methods: The reported technique suggests use of a pair of grafts, with common origin and different insertions. Experimental surgery was conducted on 25 porcine knee joints, divided as follows: Group A of 15 joints for the reported technique and group B of 10 joints for a single – bundle technique. Group A was divided in subgroups A1, A2 and A3, depending on different distances between insertion points. For surgery and testing a device was designed, with adaptors serving specimen alignment adjustments. A dial gauge was used for monitoring displacements caused by simulated drawer tests. Tests were carried out at knee flexion angles of 30, 60 and 90 degrees and with the natural ACL intact, ruptured and reconstructed. Measurements of Knee laxity were recorded

Results: In the intact condition, no statistical difference was found between specimens used to compare the two techniques (p-value equals 0,905). Overall, the double – bundle technique provided significantly lower laxity values, than the one – bundle technique (2.0 plus/minus 0.6 mm and 3.4 plus/minus 0.9 mm, respectively, with p – value less than 0.001). Laxity values obtained with the double – bundle technique were significantly lower, when adopting a large distance between insertions (p – value equals 0.016).

Conclusions: As the two techniques were compared on a uniform specimen population, results of in vitro biomechanical testing advocate that the reported double- bundle technique offered ACL reconstructions of superior stability. This is a promising technique which is deserved biggest study in vivo.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 175 - 176
1 Feb 2004
Sourlas J Papachristou G Magnissalis E Efstathopoulos N Plessas S
Full Access

Aims: The topographical measurement and representation of the ACL insertion on the tibial plateau, based on a greek population sample.

Methods: Fourty eight tibial plateaus were explanted during TKA surgery in 33 female and 15 male patients (average age of 71.2 yrs) suffering from osteoarthritis and rheumatoid arthritis. By means of a calliper, measurements were conducted in order to determine the dimensions shown. Data were used for a topographical representation.

Conclusions: To the authors’ best knowledge, this is the first such anthropometric study on a greek population and its results provide a confirmation on the relatively wide base of ACL insertion on the tibial plateau. The biomechanical performance of this natural configuration for a full range of motion, is possibly not sufficiently reproduced by conventional ACL reconstruction techniques using just one bundle.