Augmentation of Bone Patella Tendon Bone ACL Reconstruction with BMC and a Suture Tape and the Rationale Behind Biologic ACL Reconstructions

Objectives: Tranexamic acid (TXA) is a commonly used medication in orthopaedic procedures, reducing perioperative bleeding and need for transfusion. The purpose of this double-blind randomized controlled study was to evaluate if IV TXA for primary anterior cruciate ligament (ACL) reconstruction with bone-patella tendon-bone (BTB) could reduce perioperative blood loss or postoperative intra-articular hemarthrosis without postoperative drains. Methods: A controlled, randomized, double-blinded trial was conducted in 110 patients who underwent ACLR with BTB autograft. Patients were equally randomized to the control and experimental groups. The experimental group received two 1-gram boluses of IV TXA, one prior to tourniquet inflation and one prior to wound closure; the control group did not receive TXA. If a clinically significant hemarthrosis was evident, the knee was aspirated, and the volume of blood (ml) was recorded. Additionally, perioperative blood loss (ml); Visual Analog Scale (VAS) on postoperative days (POD) 1-7 and post-operative weeks (POW) 1, 6 and 12; postoperative opioid consumption POD 1-7; range of motion (ROM) and ability to straight leg raise (SLR) at POW 1, 6, 12; and pre and postoperative thigh circumference ratio (TCR). Results: There was no significant difference in perioperative blood loss between the experimental and control groups (32.5ml v. 35.6ml, p=0.47). The experimental group had 23 knees aspirated; control group had 26 knees aspirated (p=0.56). No significant difference seen in postoperative hemarthrosis volume with IV TXA (26.7ml v. 37.3ml, p=0.12). There was no significant difference in VAS score between the two groups (p=0.15), additionally, there was no difference in postoperative opioid consumption (p=0.33). There was no significant difference in ROM or ability to SLR, or pre- nor post-operative TCR (p > 0.05 for all). Conclusions: IV TXA in patients who undergo ACLR with BTB autograft does not significantly impact perioperative blood loss, postoperative hemarthrosis, or postoperative pain levels. Additionally, no significant differences were seen in early post-operative recovery regarding ROM or quadriceps reactivation.

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Characterizing the Influence of Preconditioning on Initial Tension for Hamstring Tendon and Patella Tendon Grafts

ASME 2007 Summer Bioengineering Conference ◽

10.1115/sbc2007-172333 ◽

2007 ◽

Author(s):

John J. Elias ◽

Surya P. Rai ◽

David M. Weinstein ◽

William J. Ciccone

Keyword(s):

Stress Relaxation ◽

Acl Reconstruction ◽

Knee Laxity ◽

Hamstring Tendon ◽

Patella Tendon ◽

Initial Tension ◽

Graft Tension ◽

Anterior Knee Laxity ◽

Tendon Grafts ◽

Anterior Knee

The primary goal of ACL reconstruction is to limit post-operative anterior knee laxity without over-constraining the knee. For both hamstring tendon and patella tendon grafts used for ACL reconstruction, initial graft tension is applied to limit post-operative knee laxity. Both types of graft stress relax following implantation, decreasing the graft tension. Previous studies have shown that preconditioning reduces the tension decrease due to stress relaxation for both hamstring tendons [1] and patella tendons [2]. While hamstring tendon grafts are typically preconditioned in tension on a graft board prior to implantation to limit stress relaxation, patella tendon grafts are typically implanted without preconditioning. The current study focused on characterizing the influence of preconditioning on stress relaxation for both types of graft. The authors hypothesized that the tension loss due to stress relaxation would be larger for preconditioned hamstring tendon grafts than for preconditioned patella tendon grafts.

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Anterior cruciate ligament (ACL) repair using cortical or anchor fixation with suture tape augmentation vs ACL reconstruction: A comparative biomechanical analysis

The Knee ◽

10.1016/j.knee.2021.09.003 ◽

2022 ◽

Vol 34 ◽

pp. 76-88

Author(s):

Lukas N. Muench ◽

Daniel P. Berthold ◽

Simon Archambault ◽

Maria Slater ◽

Julian Mehl ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Biomechanical Analysis ◽

Acl Repair ◽

Anterior Cruciate ◽

Anchor Fixation ◽

Suture Tape

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All-Inside Allograft ACL Reconstruction Augmented with Amnion, BMC, and a Suture Tape

Biologic and Nanoarthroscopic Approaches in Sports Medicine ◽

10.1007/978-3-030-71323-2_3 ◽

2021 ◽

pp. 17-26

Author(s):

Tyag K. Patel ◽

Dana Lycans ◽

Chad Lavender

Keyword(s):

Acl Reconstruction ◽

Suture Tape

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Self-Tensioning Feature of Knotless Suture Anchor Provides Reproducible Knotless Fixation Independent of Initial Tension

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121991593 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199159

Author(s):

Aravind Athiviraham ◽

Cody S. Lee ◽

Patrick A. Smith ◽

Marina Piepenbrink ◽

Alexander P. Mackin ◽

...

Keyword(s):

Acl Reconstruction ◽

Porcine Model ◽

Suture Anchor ◽

Cruciate Ligament ◽

Testing Machine ◽

Time Data ◽

Postoperative Rehabilitation ◽

Initial Tension ◽

Knotless Suture Anchor ◽

Suture Tape

Background: Anterior cruciate ligament (ACL) reconstruction with suture tape reinforcement has been shown to biomechanically reduce elongation and increase ultimate strength. However, the amount and consistency of the achieved tension after primary fixation using knotless suture anchors remains unclear. Purpose: To determine whether initial tensioning of suture tape before fixation with a knotless suture anchor significantly affects final tension of the suture tape. Study Design: Controlled laboratory study. Methods: We secured 15 pairs of Sawbones blocks with predrilled tunnels to a tensile testing machine. Suture tape was inserted through a suspensory fixation button on the representative femoral block and threaded top-down through the base of the tibial block over an attachable button system. The suture tape was attached with a knotless suture anchor in a predrilled and tapped hole on the tibial block under the following pretensioning conditions: (1) slight tension of 5 N, (2) no tension, and (3) initial slack. The suture anchor was inserted as the load-time data were recorded. After initial block testing, a porcine model of 24 tibias was used to test the same pretensioning conditions. The initial loads during anchor insertion and screw-in were measured, as well as final tension. Results: During block testing, no difference in final tensioning was found when comparing the slight-tension, no-tension, and slack groups (42.3 ± 5.3, 37.7 ± 6.4, and 40.2 ± 7.0 N, respectively; P = .528). Similar to block testing, no difference in final tensioning was found when comparing the slight-tension, no-tension, and slack groups using the porcine model (43.64 ± 6.69, 48.09 ± 13.93, and 44.52 ± 6.84 N, respectively; P = .633). Conclusion: The final tension of the suture tape construct appears to be reproducible and consistent, independent of the initial tension introduced with suture anchor placement within the tested parameters. Clinical Relevance: The results of the current study can help optimize the placement technique of independent suture tape reinforcement for ACL reconstruction, which is a promising strategy to help prevent ACL rerupture, particularly in the early phases of postoperative rehabilitation.

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Comparing 2-Year Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Patella-Tendon or Semitendinosus-Tendon Autografts: A Non-Randomised Prospective Study

Journal of Orthopaedic Surgery ◽

10.1177/230949900501300206 ◽

2005 ◽

Vol 13 (2) ◽

pp. 139-146 ◽

Cited By ~ 22

Author(s):

BPB Tow ◽

PCC Chang ◽

AK Mitra ◽

BK Tay ◽

MC Wong

Keyword(s):

Acl Reconstruction ◽

Cruciate Ligament ◽

Semitendinosus Tendon ◽

Knee Score ◽

Patella Tendon ◽

Anterior Translation ◽

Anterior Cruciate ◽

Tendon Autograft

Purpose. To compare the results of anterior cruciate ligament (ACL) reconstructions using either a patella-tendon autograft or a semitendinosus-tendon autograft. Methods. Based on surgeon experience and preference, 68 patients underwent ACL reconstruction using either a quadruple-strand semitendinosus autograft (n=34) or a central one-third bone-patella tendon-bone autograft (n=34). Each patient was assessed preoperatively and postoperatively at 3, 6, and 24 months using the International Knee Documentation Committee (IKDC) knee score, Biodex muscle strength and endurance testing, and the KT1000 instrumented arthrometer test of knee laxity to anterior translation. All assessments at the 2-year follow-up were performed by the same physician and physiotherapist. Results. While ACL reconstruction improved knee stability and IKDC knee scores significantly, there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation. Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness. Meniscectomy was associated with poorer long-term knee scores. Conclusion. ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up. However, we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft.

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