Biomechanical Testing of Three Alternative Quadrupled Tendon Graft Constructs With Adjustable Loop Suspensory Fixation for Anterior Cruciate Ligament Reconstruction Compared With Four-Strand Grafts Fixed With Screws and Femoral Fixed Loop Devices

2019 ◽  
Vol 47 (4) ◽  
pp. 828-836 ◽  
Author(s):  
Christopher J. Vertullo ◽  
Marina Piepenbrink ◽  
Patrick A. Smith ◽  
Adrian J. Wilson ◽  
Coen A. Wijdicks
Keyword(s):  
Failure Load ◽  
Screw Fixation ◽  
Cruciate Ligament ◽  
Total Elongation ◽  
Tendon Graft ◽  
Ultimate Failure Load ◽  
Suspensory Fixation ◽  
Ultimate Failure ◽  
Anterior Cruciate ◽  
Preparation Techniques

Background: Quadrupled semitendinosus (ST) grafts for anterior cruciate ligament (ACL) reconstruction have advantages of greater graft diameter and gracilis (G) preservation compared with doubled ST-G grafts. However, a paucity of biomechanical data are available regarding different preparation techniques for these constructs. Purpose: To biomechanically analyze 3 alternative tendon constructs fixed with adjustable suspensory fixation devices on the femur and tibia compared with a matched 4-strand construct fixed with a tibial screw and femoral fixed loop device. Study Design: Controlled laboratory study. Methods: Three alternative quadrupled tendon preparation techniques with suspensory fixation (grafts constructs A, B, and C) were compared with a 4-strand screw-fixed loop device construct (graft construct D) in matched diameter bovine tendon graft and porcine tibia models. Graft constructs were tested with a 3-stage cyclic loading protocol (1000 cycles in position control and 1000 cycles each from 10 to 250 N and from 10 to 400 N), followed by a pull to failure. In graft construct A, the graft ends were whipstitched and tied over the tibial button; in graft construct B, the graft ends functioned as pulleys; and in graft construct C, a continuous loop was created. Initial, dynamic, and total elongation, stiffness, and ultimate failure load were recorded. Results: Graft construct D had the highest initial (0.51 ± 0.29 mm) and total (3.53 ± 0.98 mm) elongation compared with the 3 quadrupled constructs ( P < .001 each). Graft construct B had lower total elongation (2.13 ± 0.31 mm) compared with graft construct A (2.40 ± 0.30 mm) ( P = .004) and graft construct C (2.53 ± 0.21 mm) ( P = .007). Graft construct C had a higher ultimate failure load (1097 ± 79 N) compared with graft construct A (988 ± 112 N) ( P = .001), graft construct B (973 ± 137 N) ( P = .022), and graft construct D, which had the lowest failure load (767 ± 182 N) ( P < .001). Conclusion: The 3 quadrupled tendon suspensory fixation constructs exhibited small yet statistically significant biomechanical differences among each other. Constructs that used tibial screw fixation had lower ultimate failure load and higher total elongation compared with the quadrupled tendon constructs. Clinical Relevance: Total elongation for the screw fixation group was higher than the threshold of clinical failure, which may allow for graft construct elongation during the postoperative rehabilitation phase. Biomechanical properties of the 3 quadrupled tendon suspensory graft constructs may be clinically comparable, albeit statistically different.

scholarly journals In Vitro Testing of 2 Adjustable-Loop Cortical Suspensory Fixation Systems Versus Interference Screw for Anterior Cruciate Ligament Reconstruction

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110316
Author(s):  
Gerardo L. Garcés ◽  
Oscar Martel ◽  
Alejandro Yánez ◽  
Ignacio Manchado-Herrera ◽  
Luci M. Motta
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Failure Load ◽  
Cruciate Ligament ◽  
Interference Screw ◽  
Yield Load ◽  
Ultimate Failure Load ◽  
Significant Difference ◽  
Ultimate Failure ◽  
Anterior Cruciate

Background: It is not clear whether the mechanical strength of adjustable-loop suspension devices (ALDs) in anterior cruciate ligament (ACL) reconstruction is device dependent and if these constructs are different from those of an interference screw. Purpose: To compare the biomechanical differences of 2 types of ALDs versus an interference screw. Study Design: Controlled laboratory study. Methods: ACL reconstruction was performed on porcine femurs and bovine extensor tendons with 3 types of fixation devices: interference screw, UltraButton (UB) ALD, and TightRope (TR) ALD (n = 10 for each). In addition to specimen testing, isolated testing of the 2 ALDs was performed. The loading protocol consisted of 3 stages: preload (static 150 N load for 5 minutes), cyclic load (50-250 N at 1 Hz for 1000 cycles), and load to failure (crosshead speed 50 mm/min). Displacement at different cycles, ultimate failure load, yield load, stiffness, and failure mode were recorded. Results: In specimen testing, displacement of the ALDs at the 1000th cycle was similar (3.42 ± 1.34 mm for TR and 3.39 ± 0.92 mm for UB), but both were significantly lower than that of the interference screw (7.54 ± 3.18 mm) ( P < .001 for both). The yield load of the UB (547 ± 173 N) was higher than that of the TR (420 ± 72 N) ( P = .033) or the interference screw (386 ± 51 N; P = .013), with no significant difference between the latter 2. In isolated device testing, the ultimate failure load of the TR (862 ± 64 N) was significantly lower than that of the UB (1879 ± 126 N) ( P < .001). Conclusion: Both ALDs showed significantly less displacement in cyclic loading at ultimate failure than the interference screw. The yield load of the UB was significantly higher than that of the other 2. The ultimate failure occurred at a significantly higher load for UB than it did for TR in isolated device testing. Clinical Relevance: Both UB and TR provided stronger fixation than an interference screw. Although difficult to assess, intrinsic differences in the mechanical properties of these ALDs may affect clinical outcomes.

scholarly journals Biomechanical Comparison of Graft Preparation Techniques for All-Inside Anterior Cruciate Ligament Reconstruction

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093803
Author(s):  
Julia Bowes ◽  
Nada Mohamed ◽  
Jonelle Jn Baptiste ◽  
Lindsey Westover ◽  
Catherine Hui ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Failure Load ◽  
Cruciate Ligament ◽  
Biomechanical Properties ◽  
Elongation Rate ◽  
Cruciate Ligament Reconstruction ◽  
Ultimate Failure ◽  
End To End ◽  
Anterior Cruciate ◽  
Preparation Techniques

Background: All-inside anterior cruciate ligament reconstruction (ACLR) is an emerging technique used to treat ACL injuries. The all-inside technique uses a 4-stranded graft made from a single tendon that is looped on itself. The 4 strands of the graft must be secured to each other to become a closed-loop structure. Various suture configurations exist to secure the graft to adjustable loop devices, and there is a lack of data to support one technique over another. In addition to the primary sutures used to fasten the graft together, accessory sutures can be tied over the button as secondary fixation. Purpose: To evaluate biomechanical properties of 4-stranded grafts prepared in 5 different configurations. Study Design: Controlled laboratory study. Methods: Porcine flexor tendons (N = 25) were prepared in 5 different configurations (n = 5 tendons per group): simple-interrupted sutures (unsecured fixation), side-to-side fixation with and without secondary fixation, and end-to-end fixation with and without secondary fixation. The grafts were put through the same mechanical testing protocol (cyclic loading, pull to failure) to measure average load at graft failure, average displacement at failure, average stiffness, and average elongation rate. Differences between graft preparation techniques were investigated using 1-way analyses of variance (ANOVAs) with post hoc t tests ( P < .05). Results: Significant 1-way ANOVAs for each biomechanical property were found. Unsecured fixation was the weakest graft preparation with the lowest stiffness (167 ± 12 N/mm), lowest ultimate failure load (637 ± 99 N), and highest elongation rate (0.0033 ± 0.0007 mm/s). End-to-end fixation without secondary fixation showed the highest ultimate failure load (846 ± 26 N), highest stiffness (212 ± 10 N/mm), and lowest rate of elongation (0.0025 ± 0.0001 mm/s). End-to-end fixation, both with and without secondary fixation, as well as side-to-side fixation with secondary fixation showed significantly higher ultimate failure loads than grafts with unsecured fixation. End-to-end fixation performed better than side-to-side fixation; however, for most variables, the difference was not statistically significant. Secondary fixation did not provide significant improvement. Conclusion: The all-inside ACL graft with simple-interrupted sutures is biomechanically inferior to a graft that has its free ends secured to the adjustable tibial loop. Adding secondary fixation to the tibial button does not significantly change the biomechanical properties. Further clinical studies are required to determine whether these findings translate into differences in clinical outcome. Clinical Relevance: All-inside ACLR is gaining popularity in hamstring ACL reconstructive techniques. These results provide surgeons with guidance on the best graft preparation method when using a single quadrupled hamstring tendon graft.

scholarly journals Biomechanical Strength of All-Inside ACL Reconstruction Grafts Using Side-to-Side and Backup Fixation

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110065
Author(s):  
Lucas Graf-Alexiou ◽  
Jillian Karpyshyn ◽  
Jonelle Jn Baptiste ◽  
Catherine Hui ◽  
Mark Sommerfeldt ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Failure Load ◽  
Cruciate Ligament ◽  
Biomechanical Properties ◽  
Total Elongation ◽  
Hamstring Tendon ◽  
Preparation Technique ◽  
Test Configuration ◽  
End To End ◽  
Anterior Cruciate

Background: The all-inside anterior cruciate ligament reconstruction (ACLR) procedure uses a single hamstring tendon folded twice and secured to itself to form a 4-stranded graft. There are several possible configurations for preparing the graft. Purpose: To investigate the biomechanical properties of a new graft preparation technique in comparison with 2 commonly used configurations. Study Design: Controlled laboratory study. Methods: Five porcine flexor tendons were prepared into the test graft configuration: side-to-side fixation with a backup fixation at the button loop (graft M). The test configuration was compared with the results of a previous study that included grafts with simple interrupted sutures (graft A; n = 5) and end-to-end fixation (graft C; n = 5). All grafts were subjected to the same mechanical testing protocol to determine the mean failure load, stiffness, rate of elongation, and total elongation during both cyclic loading and pull to failure. Differences between groups were evaluated. Results: Graft A had a significantly lower failure load (637 ± 99 N) compared with graft M (883 ± 66 N; P = .002) and graft C (846 ± 26 N; P = .002). Graft A also had significantly lower stiffness (166 ± 12 N/mm) compared with graft M (215 ± 8 N/mm; P < .001) and graft C (212 ± 11 N/mm; P < .001). Graft C had a significantly lower elongation during cyclic loading (3.42 ± 0.24 mm) compared with graft M (4.37 ± 0.74 mm; P = .026) and graft A (4.90 ± 0.88 mm; P = .006). The unsecured fixation was the weakest graft, with the lowest failure load and stiffness. The new side-to-side configuration and end-to-end configuration were equally strong. Conclusion: The new side-to-side configuration was not biomechanically superior to the end-to-end configuration; however, they were both stronger than unsecured fixation. Clinical Relevance: As the all-inside ACLR is gaining popularity, this study provides surgeons with a new method of preparing grafts and evaluates the method with respect to currently used configurations.

BIOMECHANICAL TESTING PROCEDURES IN TENDON GRAFT RECONSTRUCTIVE ACL SURGERY

2010 ◽  
Vol 22 (05) ◽  
pp. 427-436 ◽  
Author(s):  
Mahmoud Chizari ◽  
Bin Wang ◽  
Mel Barrett ◽  
Martyn Snow
Keyword(s):  
Screw Fixation ◽  
Cruciate Ligament ◽  
Biomechanical Testing ◽  
Tendon Graft ◽  
Interference Screw ◽  
Testing Procedures ◽  
Acl Surgery ◽  
Interference Screw Fixation ◽  
Anterior Cruciate ◽  
Porcine Tissues

This paper, describes the biomedical testing of an Anterior Cruciate Ligament (ACL) reconstruction using an interference screw fixation on the bovine and porcine tissues. The harvesting procedure, experimental setup, mechanical testing, and evaluation of the tendon graft interference screw fixation are all presented throughout this study. A guideline has also been introduced to evaluate the basic mechanical properties of the bone components and the tendon graft.

scholarly journals Biomechanical Comparison of Screw Fixation Versus a Cortical Button and Self-tensioning Suture for the Latarjet Procedure

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877784 ◽  
Author(s):  
Matthew T. Provencher ◽  
Zachary S. Aman ◽  
Christopher M. LaPrade ◽  
Andrew S. Bernhardson ◽  
Gilbert Moatshe ◽  
...  
Keyword(s):  
Failure Load ◽  
Screw Fixation ◽  
Bone Block ◽  
Latarjet Procedure ◽  
Suture Button ◽  
Ultimate Failure Load ◽  
Cortical Button ◽  
Ultimate Failure ◽  
The Mean ◽  
Mechanism Of Failure

Background: Metal screws are traditionally used to fix the coracoid process to the glenoid. Despite stable fixation, metal screws have been associated with hardware complications. Therefore, some studies have advocated for suture button fixation during the Latarjet procedure to reduce the complications associated with screw fixation. Purpose: To biomechanically evaluate the ultimate failure load of a cortical button and self-tensioning suture versus metal screws for coracoid graft fixation during the Latarjet procedure. Study Design: Controlled laboratory study. Methods: Eight matched pairs of fresh-frozen, male cadaveric shoulders (N = 16) underwent the Latarjet procedure. The shoulders of each pair were randomly assigned to 1 of 2 groups: fixation using two 3.75-mm cannulated, fully threaded metal screws or fixation using a double suture button construct. Specimens were secured in a dynamic testing machine and cyclically preconditioned from 2 to 10 N at 0.1 Hz for 10 cycles. After preconditioning, specimens were pulled to failure at a normalized displacement rate of 400% of the measured gauge length per minute. The ultimate failure load and mechanism of failure were recorded for each specimen. Results: The mean ultimate load to failure for screw fixation (226 ± 114 N; 95% CI, 147-305 N) was not significantly different from that for suture button fixation (266 ± 73 N; 95% CI, 216-317 N) ( P = .257). The mean strain at failure for screw fixation (63% ± 21%; 95% CI, 48%-77%) was not significantly different from that for suture button fixation (86% ± 26%; 95% CI, 69%-104%) ( P = .060). The most common mechanism of failure for the screw fixation method was at the bone block drill holes, while an intramuscular rupture at the clamp-muscle interface occurred for the suture button construct. Conclusion: The screw and suture button fixation techniques exhibited comparable biomechanical strength for coracoid bone block fixation of the Latarjet procedure. Clinical Relevance: Metal screws have been reported to be a large contributor to intraoperative and postoperative complications. Therefore, given the results of the current study, a suture button construct may be an alternative to metal screw fixation during the Latarjet procedure. However, further clinical studies are warranted.

Factors affecting biomechanical strength of Latarjet constructs: A systematic review and meta-regression

2020 ◽  
pp. 175857322096046
Author(s):  
Eric G Huish Jr ◽  
Shayne R Kelly ◽  
Brenden M Cutter
Keyword(s):  
Systematic Review ◽  
Failure Load ◽  
Screw Fixation ◽  
Shear Stresses ◽  
Glenohumeral Instability ◽  
Ultimate Failure Load ◽  
Tensile Forces ◽  
Drill Diameter ◽  
Ultimate Failure ◽  
Meta Regression

Background The Latarjet procedure reduces recurrent glenohumeral instability but has potential hardware and graft complications. The procedure has been modified to use various screw types as well as suture buttons. Biomechanical studies have evaluated the effect of these implants on construct strength. With varying results it is unclear whether there is an optimal implant to use. Methods We conducted a systematic review of human cadaveric biomechanical studies evaluating Latarjet ultimate failure load. Two independent reviewers screened articles and included them after full text review. Additional factors including implants used, graft orientation, cortices engaged, drill diameter, and screw characteristics were recorded. Meta-regression was performed on the 145 specimens from eight studies that met inclusion criteria. Results Screw fixation resulted in a 396.8 N (95% CI, 149.8–643.7) N higher ultimate failure load against shear stresses than suture buttons (p = 0.002). There were no differences between implants for ultimate failure load against tensile forces. Tensile strength was significantly affected by drill diameter with each millimeter of increase reducing the mean ultimate failure load by 127.4 N (95% CI, 41.2–213.6) N (p = 0.004). Conclusions These results suggest that using screw fixation and minimizing drill diameter can obtain the maximum ultimate failure load against both shear and tensile forces in a Latarjet construct.

scholarly journals Suture versus screw fixation technique for tibial eminence fracture: A meta-analysis of laboratory studies

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902090797
Author(s):  
Mao Ye ◽  
Jun Chen ◽  
Feng Hu ◽  
Yanxi Liu ◽  
Yang Tan
Keyword(s):  
Failure Load ◽  
Screw Fixation ◽  
Laboratory Studies ◽  
Cyclic Testing ◽  
Fixation Technique ◽  
Ultimate Failure Load ◽  
Significant Difference ◽  
Suture Group ◽  
Ultimate Failure ◽  
Screw Group

Purpose: The aim of this study was to compare the biomechanical properties between the suture fixation technique and the screw fixation technique for tibial eminence fracture (TEF). Methods: The current study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The PubMed, Embase, and the Cochrane were searched from inception to January 2019 comparing the suture and the screw fixation technique for TEF. The results of the eligible studies were analyzed in terms of stiffness, ultimate failure load, and displacement after the cyclic testing. Results: Six laboratory studies were included with a total of 114 knees: 57 knees were in the FiberWire suture group and 57 knees were in the single-screw group. The suture group had higher stiffness than the screw group, but there was no statistical difference between these two groups. Ultimate failure load in the suture group was statistically higher than that in the screw group. No statistically significant difference existed in displacement after the cyclic testing between the suture group and the screw group. Conclusion: The FiberWire suture fixation may be biomechanically superior to a single screw fixation in TEF treatment in mature knees regarding ultimate failure load, while no significant difference was found between the two fixations in terms of stiffness and displacement after the cyclic testing.

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