J Knee Surg 2022; 35(05): 539-547
DOI: 10.1055/s-0040-1716371
Original Article

Effect of Geometry on the Fixation Strength of Anterior Cruciate Ligament Reconstruction Using BASHTI Technique

Hadi Moeinnia
1   Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
Amir Nourani
1   Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
Amirhossein Borjali
1   Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
Mahdi Mohseni
1   Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
Narges Ghias
1   Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
Hossein Korani
1   Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
Mahmoud Chizari
2   Department of Engineering and Technology, School of Engineering and Computer Sciences, University of Hertfordshire, Hatfield, Hertfordshire, United Kingdom
› Author Affiliations


The goal of this study is to investigate the effects of tendon and cannulated drill bit diameter on the strength of the bone and site hold tendon inside (BASHTI) fixation technique for an anterior cruciate ligament (ACL) reconstruction. Bovine digital tendons and Sawbones blocks were used to mimic the ACL reconstruction. Mechanical strength of the specimens was measured using a cyclic loading continued by a single cycle pullout load until failure to simulate the real postsurgical loading conditions. Finally, failure modes of specimens and ultimate failure load were recorded. The maximum possible tendon surface strain (i.e., tendon compression [TC]) for tendon diameters of 6, 7, 8, and 9 mm were 0.73, 0.8, 0.7, and 0.65, respectively. Eighty per cent of the specimens with tendon diameter of 6 mm and 20% of specimens with tendon diameter of 7 mm failed on the torn tendon. All samples with larger tendon diameters (i.e., 8 and 9 mm) failed on the fixation slippage. The maximum fixation strength according to the most suitable core bones for 6, 7, 8, and 9 mm tendons were 148 ± 47 N (core 9.5 mm), 258 ± 66 N (core 9.5 mm), 386 ± 128 N (core 8.5 mm), and 348 ± 146 N (core 8.5 mm), respectively. The mode of tendon failure was significantly influenced by the tendon diameter. Also, an increase in TC raised the fixation strength for all tendon diameters; however, tendon over compression decreased the fixation strength for the 8 mm tendon group. Finally, an empirical equation was proposed to predict BASHTI fixation strength.


This research was performed at Biomechanics Laboratory, Sharif University of Technology.

Ethical Approval

All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted. These tests were approved by Sharif Ethics Committee with 45784 permit number. Each author certifies that his or her institution approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. Informed consent was obtained from all individual participants included in the study.

Authors' Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Hadi Moeinnia, Amirhossein Borjali, Mahdi Mohseni, Narges Ghias, and Hossei Korani. The first draft of the manuscript was written by Hadi Moeinnia and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Publication History

Received: 23 January 2020

Accepted: 21 July 2020

Article published online:
08 September 2020

© 2020. Thieme. All rights reserved.

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