Sheathed fixation improves BASHTI technique in an anterior cruciate ligament reconstruction

Amirhossein Borjali, GholamHossein Farrahi, Mahmoud Chizari

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Bone and Site Hold Tendon Inside (BASHTI) technique is an implant-less surgical methodology used for anterior cruciate ligament (ACL) reconstruction. It has some clinical advantages, such as speeding up the healing process. Since the force required to insert the core bone inside the tunnel may damage the core bone and affect the fixation process, the study aims to investigate the strength of fixation of BASHTI technique using proposed sheathed core bones. Experimental tests were performed to evaluate the biomechanical strength of the fixation. Synthetic bone combined with bovine tendons as a graft was used. Polymers were used to create the sheath for mechanical testing. The results showed that fixation strength and stiffness in PTFE sheath with 0.1 mm were 343.86 N and 114.62 N/mm and in PVC sheath with similar thickness, 235.95 N, and 93.36 N/mm. Subsequently, 0.2 mm PTFE sheaths were tested in two different sections: incomplete fixation and complete fixation. The strength and stiffness of the first section were 221.6 N and 66.99 N/mm and for the second section 420.02 N and 126.16 N/mm. Using sheath facilitates the fixation process in BASHTI technique. The 0.1 mm PTFE sheath and 0.2 mm PTFE sheath with complete fixation provide higher fixation strength than other groups. The outcome showed that engaged length has a direct effect on the fixation strength. The BASHTI technique offers an implant-less organic ACL reconstruction method that can improve the fixation method and speed up the healing process.
Original languageEnglish
Pages (from-to)375-384
Number of pages10
JournalProceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine
Issue number3
Early online date11 Feb 2023
Publication statusPublished - 30 Mar 2023


  • Original Articles
  • ACL reconstruction
  • BASHTI technique
  • core bone
  • sheath
  • implant-less
  • fixation strength
  • Anterior Cruciate Ligament Injuries/surgery
  • Polytetrafluoroethylene
  • Anterior Cruciate Ligament/surgery
  • Anterior Cruciate Ligament Reconstruction/methods
  • Biomechanical Phenomena
  • Animals
  • Cattle
  • Tendons/surgery


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