All-Inside Allograft ACL Reconstruction Augmented with Amnion, BMC, and a 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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Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears With Suture Augmentation

Video Journal of Sports Medicine ◽

10.1177/26350254211005461 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542110054

Author(s):

Harmen D. Vermeijden ◽

Jelle P. van der List ◽

Gregory S. DiFelice

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Failure Rate ◽

Suture Anchor ◽

Primary Repair ◽

Cruciate Ligament ◽

Tissue Quality ◽

Acl Repair ◽

Anterior Cruciate ◽

Suture Tape

Background: Historically, the midterm outcomes of open anterior cruciate ligament (ACL) repair were rather disappointing, and ACL reconstruction subsequently became the surgical standard for ACL injuries. Recent studies, however, have shown that there might be a role for arthroscopic primary repair in appropriately selected patients with proximal ACL tears. Indications: Due to more prominent blood supply in the proximal ligament region, ACL repair should only be performed in patients with proximal tears and good-to-excellent tissue quality. Although all patients are potential candidates, this procedure is preferably performed acutely and in adult patients. Technique Description: First, it is identified whether a proximal tear with good tissue quality is present. Then, both ACL bundles are sutured individually from distal to proximal using a Bunnell-type pattern and a self-retrieving suture passer. The posterolateral bundle is then reattached first in anatomical fashion, using a 4.75-mm vented biocomposite suture anchor. Next, the suture anchor of the anteromedial bundle is preloaded with an internal suture tape augmentation. After anchor deployment, the suture tape augmentation is channeled through a small 2.5-mm tibial tunnel in the anterior third of the tibial ACL footprint. Finally, the suture augmentation is tensioned near full extension and fixed to the tibia’s anteromedial cortex using single suture anchor fixation. Results: Recently, we have published a series of the first 113 consecutive repair patients with minimum 2-year follow-up, of which 60 received additional suture augmentation. In this cohort, the overall failure rate was 13%, which was similar to 3 other studies on modern-day ACL repair (range: 5%-15%). Subgroup analysis showed that the failure rate was much higher in patients ≤ 21 years (38%) but low in patients >21 years (0%). Finally, it has been shown that there is an earlier return of knee motion, complications are rare, and there is less joint awareness after ACL repair as compared with ACL reconstruction. Conclusion: Selective, modern-day, arthroscopic primary ACL repair with suture augmentation seems to be a good alternative to ACL reconstruction in carefully selected patients, which include patients with proximal tears and good tissue quality and aged ≤ 22 years.

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The Addition of Suture Tape to the Hamstring Graft Construct Does Not Reduce Instrumented Knee Laxity Following ACL Reconstruction

Arthroscopy, Sports Medicine, and Rehabilitation ◽

10.1016/j.asmr.2021.11.015 ◽

2021 ◽

Author(s):

Richard J. Allom ◽

Jil A. Wood ◽

Darren B. Chen ◽

Samuel J. MacDessi

Keyword(s):

Acl Reconstruction ◽

Knee Laxity ◽

Hamstring Graft ◽

Suture Tape

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Intra-Articular Biocompatibility of Multistranded, Long-Chain Polyethylene Suture Tape in a Canine ACL Model

The Journal of Knee Surgery ◽

10.1055/s-0038-1655765 ◽

2018 ◽

Vol 32 (06) ◽

pp. 525-531 ◽

Cited By ~ 4

Author(s):

Patrick A. Smith ◽

Chantelle C. Bozynski ◽

Keiichi Kuroki ◽

Sarah M. Henrich ◽

Coen A. Wijdicks ◽

...

Keyword(s):

Articular Cartilage ◽

Postoperative Complications ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Cartilage Damage ◽

Cartilage Degeneration ◽

Case Scenario ◽

Worst Case ◽

Study Results ◽

Suture Tape

AbstractThe purpose of this study was to assess intra-articular use of a nonabsorbable braided suture tape for its biocompatibility when implanted adjacent to the native anterior cruciate ligament (ACL) in a canine model. Establishing biocompatibility of suture tape in the knee is an important foundational step for clinicians considering use of suture tape augmentation for ACL reconstruction or repair. The study hypothesis was that a nonabsorbable braided suture tape would be biocompatible in the knee with no resultant adverse functional consequences, and no significant intra-articular synovial reactions or articular cartilage degeneration attributable to direct exposure to the suture tape, whether intact or transected. Nonabsorbable braided suture tape was arthroscopically implanted adjacent to the native ACL of dogs (n = 6). The suture was intact in half of the dogs and was transected in the other half as a “worst-case” scenario. Dogs were assessed for postoperative complications and morbidity. Arthroscopic grading of synovium and cartilage was performed at 4 and 6 months. Histologic assessments were performed at the 6-month endpoint and compared with the ACL partial tear (n = 9) and ACL reconstruction (n = 5) cohorts as well as historical sham controls. No postoperative complications were noted. No animal developed lameness or clinical dysfunction, and there were no severe inflammatory or immune responses, cartilage erosions, or premature osteoarthritis noted. Arthroscopic assessments revealed no to mild synovitis and no apparent cartilage damage in either group. Histologically, both the intact and transected suture tape groups were associated with significantly (p ≤ 0.05) less synovial and articular cartilage pathology compared with the partial ACL transection and patellar bone–tendon–bone ACL autograft reconstruction cohorts, and matched historical sham controls. The hypothesis was accepted as study results support the biocompatibility of suture tape in the canine knee.

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Independent Suture Tape Internal Brace Reinforcement of Bone–Patellar Tendon–Bone Allografts: Biomechanical Assessment in a Full-ACL Reconstruction Laboratory Model

The Journal of Knee Surgery ◽

10.1055/s-0039-1692649 ◽

2019 ◽

Vol 33 (10) ◽

pp. 1047-1054 ◽

Cited By ~ 1

Author(s):

Patrick A. Smith ◽

James P. Bradley ◽

John Konicek ◽

Jordan A. Bley ◽

Coen A. Wijdicks

Keyword(s):

Acl Reconstruction ◽

Patellar Tendon ◽

Interference Screw ◽

Bone Allografts ◽

Significant Difference ◽

Internal Bracing ◽

Internal Brace ◽

Cyclic Displacement ◽

Bone Patellar Tendon ◽

Suture Tape

AbstractInternal bracing for anterior cruciate ligament (ACL) surgery is a relatively new concept. The purpose of this study was to evaluate the effects of an “independent” button-fixed internal brace on the biomechanical properties of ACL reconstruction in a full-construct experimental model. Three groups (n = 10 each) were tested in a full-construct porcine-bone model with human bone–patellar tendon–bone allografts using different reconstruction techniques: interference screw fixation on femur and tibia (S-S group), adjustable-loop device (ALD) fixation on the femur with tibial interference screw without suture tape (ALD-S group), and with internal brace (ALD-S-IB group). Measured outcomes included cyclic displacement, stiffness, and ultimate load to failure. The ALD-S-IB group (2.9 ± 0.8 mm) displaced significantly less than the ALD-S (4.2 ± 0.9 mm; p = 0.015) and S-S group (4.3 ± 1.1 mm; p = 0.017). No significant difference was found between the ALD-S and the S-S group. Construct stiffness was significantly higher for the ALD-S-IB group (156 ± 23 N/mm) and the ALD-S group (122 ± 28 N/mm) than for the S-S group (104 ± 40 N/mm; p = 0.003 and p = 0.0042), but there was no significant difference between both ALD groups. Similarly, ultimate loads in the ALD-S-IB (758 ± 128 N) and the ALD-S groups (628 ± 223 N) were significantly greater than in the S-S group (416 ± 167 N; p < 0.001 and p = 0.025), but there was no significant difference between ALD groups. Adding an internal brace reinforcement to an ALD in a full-construct experimental model significantly decreased cyclic displacement by 31% without increasing construct stiffness or ultimate load significantly. These results indicate that suture tape internal bracing of bone–patellar tendon–bone allograft ACL reconstruction decreases cyclic displacement during experimental testing, which has clinical implications regarding initial construct stability.

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