scholarly journals All Soft-suture Anchor versus Suture Bridge Construct for Insertional Achilles

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0006
Author(s):  
Kenneth Hunt ◽  
Pam Kumparatana ◽  
Sophia Anderson ◽  
Todd Baldini ◽  
Daniel Moon ◽  
...  
Keyword(s):  
Failure Load ◽  
Lateral Displacement ◽  
Clinical Failure ◽  
Suture Anchors ◽  
Suture Bridge ◽  
Ultimate Failure Load ◽  
Failure Loads ◽  
Tendon Thickness ◽  
Ultimate Failure ◽  
Group 2

Category: Ankle Introduction/Purpose: New techniques and anchors have been developed for the surgical treatment of insertional Achilles tendinopathy and rupture to allow for earlier return to postoperative weight bearing and accelerated rehabilitation. Two recently introduced soft tissue-to-bone anchor technology have purported advantages for insertional Achilles repairs. Knotless suture anchors allow suture tension to be precisely controlled with a ratcheting mechanism. The other is a suture bridge construct fastened with biotenodesis screws, increasing the soft tissue footprint and reducing the risk of suture pullout through the tendon. However, neither technology has been studied in a biomechanical model of Achilles tendon repair. We hypothesized that there would be no difference in the biomechanical characteristics of a single-row all-suture anchor repair to a double-row repair with knotless anchors and suture tape. Methods: Six matched-pairs of fresh-frozen lower leg cadaveric specimens (12 total) were obtained. All tendons were completely detached from their calcaneal insertions and tendon thickness was measured. Calcaneal exostectomies were performed (e.g., Haglunds removal) above the Achilles insertion. Group 1 was repaired with a single-row construct with two all-soft anchors. Group 2 was repaired with a double-row suture bridge construct with two knotless anchors distally and two suture tape anchors proximally. The repaired specimens were cyclically loaded from 10N to 100N at 1 Hz for 2,000 cycles then to failure at 1mm/sec. A motion capture system measured Achilles-calcaneal displacement at the medial and lateral anchors. Paired t-tests and linear mixed models (LMMs) were used to analyze the following outcomes: clinical failure load, ultimate failure load, Achilles-calcaneal medial and lateral displacement, distance at ultimate failure load, tendon thickness, footprint, and mode of failure. A p-value of <0.05 was considered statistically significant. Results: Group 2 showed significantly less Achilles-calcaneal overall medial and lateral displacement, 19.5% and 36.9% respectively (Table 1). Group 2 showed a statistical trend toward greater clinical and ultimate failure load, 23.8% and 34.2%, respectively (Table1). LMM analyses showed that a suture bridge repair over all-soft anchor repair was independently associated with a 50.24N increase in the load to clinical failure (p=0.0011). Higher clinical failure loads were associated with higher BMI (p<0.0001), thinner tendons (p<0.0001), and smaller tendon footprints on the calcaneus (p=0.0013). Higher absolute failure loads were associated with older age (p<0.0001), higher BMI (p<0.0001), thinner tendons (p=0.0028), and larger footprints (p<0.0001). Conclusion: These data suggest a trend toward higher clinical and ultimate failure loads in a suture bridge construct compared to all-soft suture anchors for insertional Achilles repair. Loads to failure in both groups were higher than previously reported pull-out strengths for most suture anchors (150-300 N), but are lower than typical loads at the Achilles insertion during walking activities. The use of the suture bridge repair method may result in superior loads to failure compared to all-soft anchors. Patient age, BMI and tendon thickness impact failure loads. Adequate healing should be allowed followed repair of complete Achilles detachment.

scholarly journals Different Suture Materials for Arthroscopic Transtibial Pull-out Repair of Medial Meniscal Posterior Root Tears: A Human Biomechanical Study

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711987327
Author(s):  
Gilberto Y. Nakama ◽  
Zachary S. Aman ◽  
Hunter W. Storaci ◽  
Alexander S. Kuczmarski ◽  
Joseph J. Krob ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Failure Load ◽  
Clinical Care ◽  
Posterior Root ◽  
Clinical Failure ◽  
Postoperative Rehabilitation ◽  
Pull Out ◽  
Ultimate Failure Load ◽  
Ultimate Failure ◽  
Suture Tape

Background: Transtibial pull-out repair of the medial meniscal posterior root (MMPR) has been largely assessed through biomechanical studies. Biomechanically comparing different suture types would further optimize MMPR fixation and affect clinical care. Purpose/Hypothesis: The purpose of this study was to determine the optimal suture material for MMPR fixation. It was hypothesized that ultra high–molecular weight polyethylene (UHMWPE) suture tape would be biomechanically superior to UHMWPE suture and standard suture. Study Design: Controlled laboratory study. Methods: The MMPR attachment was divided in 24 human cadaveric knees and randomly assigned to 3 repair groups: UHMWPE suture tape, UHMWPE suture, and standard suture. Specimens were dissected down to the medial meniscus, and the posterior root attachments were sectioned off the tibia. Two-tunnel transtibial pull-out repair with 2 sutures, as determined by the testing group, was performed. The repair constructs were cyclically loaded between 10 and 30 N at 0.5 Hz for 1000 cycles to mimic the forces experienced on the medial meniscus during postoperative rehabilitation. Displacement was recorded at 1, 50, 100, 500, and 1000 cycles. Ultimate failure load, displacement at failure, and load at 3 mm of displacement (clinical failure) were also recorded. Results: UHMWPE suture tape had significantly less displacement of the medial meniscus when compared with standard suture at 1 (–0.22 mm [95% CI, –0.41 to –0.02]; P = .025) and 50 (–0.35 mm [95% CI, –0.67 to –0.03]; P = .029) cycles. There were no other significant differences observed in displacement between groups at any number of cycles. UHMWPE suture tape had significantly less displacement at the time of failure than standard suture (–3.71 mm [95% CI, –7.17 to –0.24]; P = .034). UHMWPE suture tape had a significantly higher load to reach the clinical failure displacement of 3 mm than UHMWPE suture (15.64 N [95% CI, 0.02 to 31.26]; P = .05). There were no significant differences in ultimate failure load between groups. Conclusion: The meniscal root repair construct with UHMWPE suture tape may be stronger and less prone to displacement than that with standard suture or UHMWPE suture. Clinical Relevance: UHMWPE suture tape may provide better clinical results compared with UHMWPE suture and standard suture.

Biomechanical Evaluation of Classic Solid and All-Soft Suture Anchors for Medial Patellofemoral Ligament Reconstruction

2017 ◽  
Vol 45 (7) ◽  
pp. 1622-1626 ◽  
Author(s):  
Michael G. Saper ◽  
Karim Meijer ◽  
Scott Winnier ◽  
John Popovich ◽  
James R. Andrews ◽  
...  
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Failure Load ◽  
Articular Surface ◽  
Mpfl Reconstruction ◽  
Suture Anchors ◽  
Ultimate Failure Load ◽  
Mode Of Failure ◽  
Fixation Techniques ◽  
Fresh Frozen ◽  
Ultimate Failure

Background: Multiple techniques for patellar fixation with classic solid suture anchors (SAs) in medial patellofemoral ligament (MPFL) reconstruction have been described. Fixation of the graft to the patella with all-soft suture anchors (ASAs) has not been studied. Purpose/Hypothesis: To evaluate the biomechanical performance of 2 different MPFL patellar fixation techniques: ASA fixation and SA fixation. We hypothesized that the ASA group would show no statistical difference in the ultimate failure load and stiffness compared with the SA group. Study Design: Controlled laboratory study. Methods: Reconstruction of the MPFL with gracilis autografts was performed in 16 fresh-frozen cadaveric knees (mean age, 52.6 ± 9.0 years). The specimens were randomly assigned to 2 groups of 8 specimens each based on the method used to fix the graft to the medial patella: ASA or SA fixation. Patellar fixation with ASAs was completed with 2 parallel 1.8-mm anchors (Q-Fix, Smith & Nephew). Fixation with SAs was completed with 2 parallel 2.9-mm anchors (Osteoraptor, Smith & Nephew). The reconstructions were cyclically loaded for 10 cycles to 25 N and then loaded in tension at 6 mm/s until failure. Ultimate failure load (N), displacement (mm), stiffness (N/mm), and mode of failure were recorded for each specimen. Results: Load to failure testing showed an ultimate failure load of 228.5 ± 53.1 N in the ASA group. In the SA group, the ultimate failure load was 156.2 ± 84.9 N. The difference between the 2 groups was not statistically significant ( P = .064). Stiffness values between the ASA and SA groups were not significantly different (21.3 ± 4.1 N/mm vs 20.9 ± 9.3 N/mm, respectively, P = .905). The most common mode of failure in both groups was anchor pullout (8 of 8 in the ASA group; 6 of 8 in the SA group). Conclusion: This experimental study showed no statistically significant differences in biomechanical performance between 1.8-mm ASAs and 2.9-mm SAs. Clinical Relevance: Patellar fixation with 2 parallel ASAs may provide adequate patellar fixation for MPFL reconstruction, while their smaller diameter could potentially decrease the risks for patella fracture and violation of the articular surface in the cadaver model.

The evaluation of the failure loads of plane frames

1968 ◽  
Vol 306 (1486) ◽  
pp. 297-311 ◽  
Keyword(s):  
Failure Load ◽  
Plastic Hinge ◽  
Second Order ◽  
Order Effects ◽  
Deformation Characteristics ◽  
Computer Approach ◽  
Ultimate Failure Load ◽  
Plane Frames ◽  
Failure Loads ◽  
Ultimate Failure

The significance of the ultimate failure load of a structure is widely recognized, yet its determination has been a considerable task. Various propositions have been put forward since the formulation of the well-known plastic theory. These have been either of empirical nature such as the Merchant-Rankine formula or laborious such as the method of following the sequence of hinge formation. In this paper the main propositions are discussed briefly. A method is then presented to evaluate the failure loads of plane frames without following the sequence of plastic hinge formation. Instead the method utilizes the elastic as well as plastic load-deformation characteristics of frames, including the second-order effects involved in both. The theoretical validity of the proposed method is studied and illustrative examples are given. Comparisons are then made with experimental observations on frames loaded proportionally up to collapse. A summary of a computer approach is presented, but throughout the paper atten­tion is also paid to manual procedures.

scholarly journals A Biomechanical Assessment of Biceps Femoris Repair Techniques

2018 ◽  
Vol 6 (1) ◽  
pp. 232596711774889 ◽  
Author(s):  
Eric A. Branch ◽  
Dustin Loveland ◽  
Sohale Sadeghpour ◽  
Adam W. Anz
Keyword(s):  
Failure Load ◽  
Testing Machine ◽  
Biceps Femoris ◽  
Materials Testing ◽  
Suture Anchors ◽  
Suture Bridge ◽  
Transosseous Repair ◽  
Failure Loads ◽  
The Mean ◽  
Repair Techniques

Background: Knee injuries encountered in clinical practice can involve avulsions of the biceps femoris from the fibula and proximal tibia. Advances in tendon repair methods now allow for repairs with increased surface areas using modern suture anchor techniques. Despite descriptions of repair techniques, there are no biomechanical studies on the biceps femoris for comparison. Purpose/Hypothesis: The objective of this controlled laboratory study was to determine the failure load of the native biceps femoris distal insertion and to evaluate modern repair techniques. Our hypothesis was 2-fold: (1) Suture repairs to the tibia and fibula would perform better on tensile testing than repairs to the fibula alone, and (2) complex bridge repairs, similar to those frequently used in rotator cuff surgery, would perform better on tensile testing than simple repairs. Study Design: Controlled laboratory study. Methods: A total of 40 paired, fresh-frozen cadaveric specimens were dissected, identifying the biceps femoris and its insertion on the proximal tibia and fibula. The native biceps femoris footprint was left intact in 8 specimens and tested to failure on a uniaxial materials testing machine evaluating tensile properties, while in the other 32 specimens, the biceps femoris insertion was dissected using a No. 15 scalpel blade, underwent repair, and was then tested to failure on a uniaxial materials testing machine evaluating tensile properties. Four repair constructs were evaluated, with 8 specimens allocated for each: construct 1 involved a simple repair (ie, passing suture through tissue in a running Krackow fashion and tying at the anchor site) to the fibula with 2 suture anchors, construct 2 involved a simple repair to the fibula and tibia with 3 suture anchors, construct 3 was a fibular repair with a tibial suture bridge involving the fibula and tibia and 3 suture anchors, construct 4 involved a transosseous repair through the fibula and 1 suture anchor on the tibia. Analysis of variance was used to evaluate for significance of the mean failure load and stiffness between groups. Results: The mean (±95% CI) failure loads were the following: native biceps femoris, 1280 ± 247.0 N; simple fibular repair, 173 ± 84.6 N; simple fibular and tibial repair, 176 ± 48.1 N; fibular repair with tibial suture bridge, 191 ± 78.5 N; and transosseous repair, 327 ± 66.3 N. The mean stiffness values were the following: native, 46 ± 13.0 N/mm; simple fibular repair, 16 ± 5.1 N/mm; simple fibular and tibial repair, 14 ± 5.4 N/mm; fibular repair with tibial suture bridge, 13 ± 2.8 N/mm; and transosseous repair, 15 ± 2.5 N/mm. Interconstruct comparison of failure loads revealed no statistical difference between constructs utilizing anchors alone. The transosseous repair showed a significant difference for the failure load when compared with each anchor repair construct ( P = .02, .02, and .04 for constructs 1, 2, and 3, respectively). Interconstruct comparison of stiffness revealed no statistical difference between all constructs ( P > .86). None of the repair techniques re-created the failure load or stiffness of the native biceps femoris tendon ( P = .02). Conclusion: In this biomechanical study, no difference was found between the mean failure loads of different biceps femoris repair constructs involving suture anchors alone and No. 2 braided polyester and ultra–high-molecular-weight polyethylene suture. A technique involving transosseous fibular tunnels and 2-mm suture tape illustrated a greater mean failure load than repairs relying on suture anchors for fixation. Clinical Relevance: Understanding the tensile performance of biceps femoris repair constructs aids clinicians with preoperative and intraoperative decisions. Current biceps femoris repair techniques do not approximate the native strength of the tendon. A transosseous style of repair offers the highest failure load.

scholarly journals Axial Compression Behavior of Ferrocement Geopolymer HSC Columns

Polymers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 3789
Author(s):  
Taha Awadallah El-Sayed
Keyword(s):  
Axial Compression ◽  
Failure Load ◽  
Volume Fraction ◽  
Low Cost ◽  
Cementitious Materials ◽  
Concrete Cover ◽  
Wire Mesh ◽  
Ultimate Failure Load ◽  
Failure Loads ◽  
Ultimate Failure

Geopolymer concrete (GC) is a substantial sort that is created by utilizing metakaolin, ground granulated blast furnace slag (GGBS), silica fumes, fly ash, and other cementitious materials as binding ingredients. The current study concentrated on the structural behavior of the ferrocement geopolymer HSC-columns subjected to axial loading and produced using rice straw ash (RSA). The major goal of this research was to use the unique features of the ferrocement idea to manufacture members that function as columns bearing members. As they are more cost-effective and lower in weight, these designed elements can replace traditional RC members. The study also intended to reduce the cost of producing new parts by utilizing low-cost materials such as light weight expanded and welded wire meshes, polyethylene mesh (Tensar), and fiber glass mesh. For this purpose, an experimental plan was conducted and a finite element prototype with ANSYS2019-R1 was implemented. Nine geopolymer ferrocement columns of dimensions of 150 mm × 150 mm × 1600 mm with different volume-fraction and layers as well as a number of metallic and nonmetallic meshes were examined under axial compression loading until failure. The performance of the geopolymer columns was examined with consideration to the mid-span deflection, ultimate failure load, first crack load with various phases of loading, the cracking patterns, energy absorption and ductility index. Expanded or welded ferrocement geopolymer columns showed greater ultimate failure loads than the control column. Additionally, using expanded or welded columns had a considerable effect on ultimate failure loads, where the welded wire mesh exhibited almost 28.10% compared with the expanded wire mesh. Columns reinforced with one-layer of nonmetallic Tensar-mesh obtained a higher ultimate failure load than all tested columns without concrete cover spalling. The analytical and experimental results were in good agreement. The results displayed an accepted performance of the ferrocement geopolymer HSC-columns.

scholarly journals Biomechanical evaluation of a novel double rip-stop technique with medial row knots for rotator cuff repair

2020 ◽  
Vol 9 (6) ◽  
pp. 285-292
Author(s):  
Zhanwen Wang ◽  
Hong Li ◽  
Zeling Long ◽  
Subin Lin ◽  
Andrew R. Thoreson ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Failure Modes ◽  
Failure Load ◽  
Biomechanical Properties ◽  
Gap Formation ◽  
Ultimate Failure Load ◽  
Fresh Frozen ◽  
Ultimate Failure ◽  
Cuff Repair

Aims Many biomechanical studies have shown that the weakest biomechanical point of a rotator cuff repair is the suture-tendon interface at the medial row. We developed a novel double rip-stop (DRS) technique to enhance the strength at the medial row for rotator cuff repair. The objective of this study was to evaluate the biomechanical properties of the DRS technique with the conventional suture-bridge (SB) technique and to evaluate the biomechanical performance of the DRS technique with medial row knots. Methods A total of 24 fresh-frozen porcine shoulders were used. The infraspinatus tendons were sharply dissected and randomly repaired by one of three techniques: SB repair (SB group), DRS repair (DRS group), and DRS with medial row knots repair (DRSK group). Specimens were tested to failure. In addition, 3 mm gap formation was measured and ultimate failure load, stiffness, and failure modes were recorded. Results The mean load to create a 3 mm gap formation in the DRSK and DRS groups was significantly higher than in the SB group. The DRSK group had the highest load to failure with a mean ultimate failure load of 395.0 N (SD 56.8) compared to the SB and DRS groups, which recorded 147.1 N (SD 34.3) and 285.9 N (SD 89.8), respectively (p < 0.001 for both). The DRS group showed a significantly higher mean failure load than the SB group (p = 0.006). Both the DRS and DRSK groups showed significantly higher mean stiffness than the SB group. Conclusion The biomechanical properties of the DRS technique were significantly improved compared to the SB technique. The DRS technique with medial row knots showed superior biomechanical performance than the DRS technique alone.

Biomechanical Comparison of All-Soft Suture Anchor Single-Row vs Double-Row Bridging Construct for Insertional Achilles Tendinopathy

2020 ◽  
pp. 107110072095902
Author(s):  
Eric Lakey ◽  
Pam Kumparatana ◽  
Daniel K. Moon ◽  
Joseph Morales ◽  
Sophia Elizabeth Anderson ◽  
...  
Keyword(s):  
Suture Anchor ◽  
Early Mobilization ◽  
Achilles Tendinopathy ◽  
Matched Pair ◽  
Clinical Failure ◽  
Suture Anchors ◽  
Double Row ◽  
Single Row ◽  
Suture Bridge ◽  
Insertional Achilles Tendinopathy

Background: Two common operative fixation techniques for insertional Achilles tendinopathy are the use of all-soft suture anchors vs synthetic anchors with a suture bridge. Despite increasing emphasis on early postoperative mobilization, the biomechanical profile of these repairs is not currently known. We hypothesized that the biomechanical profiles of single-row all-soft suture anchor repairs would differ when compared to double-row suture bridge repairs. Methods: Achilles tendons were detached from their calcaneal insertions on 6 matched-pair, fresh-frozen cadaver through-knee amputation specimens. Group 1 underwent a single-row repair with all-soft suture anchors. Group 2 was repaired with a double-row bridging suture bridge construct. Achilles-calcaneal displacement was tracked while specimens were cyclically loaded from 10 to 100 N for 2000 cycles and then loaded to failure. Linear mixed models were used to analyze the independent effects of age, body mass index, tendon morphology, repair construct, and footprint size on clinical and ultimate failure loads, Achilles-calcaneal displacement, and mode of failure. Results: The suture bridge group was independently associated with an approximately 50-N increase in the load to clinical failure (defined as more than 5 mm tendon displacement). There was no difference in ultimate load to failure or tendon/anchor displacement between the 2 groups. Conclusion: This cadaveric study found that a double-row synthetic bridge construct had less displacement during cyclic loading but was not able to carry more load before clinical failure when compared to a single-row suture anchor construct for the operative repair of insertional Achilles tendinopathy. Clinical Relevance: Our data suggest that double-row suture bridge constructs increase the load to clinical failure for operative repairs of insertional Achilles tendinopathy. It must be noted that these loads are well below what occurs during gait and the repair must be protected postoperatively without early mobilization. This study also identified several clinical factors that may help predict repair strength and inform further research.

Prestressed concrete masonry walls subjected to uniform out-of-plane loading

1993 ◽  
Vol 20 (6) ◽  
pp. 969-979
Author(s):  
J. L. Dawe ◽  
G. G. Aridru
Keyword(s):  
Prestressed Concrete ◽  
Failure Load ◽  
Masonry Walls ◽  
Prestressing Force ◽  
Concrete Masonry ◽  
Ultimate Failure Load ◽  
Wall Stiffness ◽  
Out Of Plane ◽  
Ultimate Failure ◽  
Concrete Masonry Walls

Two series of post-tensioned concrete masonry walls subjected to uniform lateral loading were tested to investigate their flexural strength behaviour. Each series of walls consisted of four full-scale prestressed specimens, with varying levels of prestressing force, and one reinforced specimen. Of particular interest were the load–deflection curves, initial cracking loads, wall stiffness, crack patterns, and ultimate failure loads. An air bag test apparatus was used for applying lateral uniform pressures to the specimens. Results of this experimental investigation showed that, for a given wall thickness, increased prestressing force increases the cracking load, initial wall stiffness, and ultimate failure load. The results have established a linear relationship between increased prestressing force and initial cracking load, initial wall stiffness, and ultimate failure load. The proposed model, which takes into account changes in wall stiffness after initial cracking of the wall, accurately predicts wall behaviour. Key words: masonry, prestressed, walls, strength, behaviour, uniform, pressure, experimental, analytical.

scholarly journals Efficacy of Bone Marrow-Stimulating Technique in Rotator Cuff Repair

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0008
Author(s):  
İsmail Kerem Bilsel ◽  
Fatih Yıldız ◽  
Mehmet Kapıcıoglu ◽  
Gokcer Uzer ◽  
Mehmet Elmadag ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Rotator Cuff ◽  
Failure Load ◽  
Tendon Healing ◽  
Histological Evaluation ◽  
Control Group ◽  
Time Interval ◽  
Lesser Tuberosity ◽  
Ultimate Failure Load ◽  
Ultimate Failure

Background: This study investigates the effect of microfracture as a bone marrow-stimulating(BMS) technique on rotatory cuff(RC) healing using a chronic RC tear model. Methods: Chronic retracted RC tendon tear model was created in the subscapularis(SSC) tendons of 20 New Zealand rabbits, bilaterally. The tendons were repaired after eight weeks using a single-row configuration with suture anchors. In right shoulders, tendons were repaired in a standard fashion(control group). In left shoulders, microfractures were performed on the SSC footprint before repair(microfracture group). The animals were sacrificed 8 and 16 weeks after repair. The repaired tendons were tested biomechanically for their ultimate failure load, linear stiffness and elongation at failure. Gross and histological evaluation of the tendon-to-bone healing was evaluated. Results: In every sample, the SSC tendon was attached to its footprint on the lesser tuberosity. In microfracture group, collagen fibers were organized in relatively ticker bundles at both time intervals. The mean ultimate failure load of microfracture was significantly greater than that of control group at 8 (148.4+31 N vs. 101.4+26 N; p=0.011) and 16 (155+30 N vs. 114.9+25 N; p=0.017) weeks after repair, respectively. There were no significant differences between the two groups at each time interval for linear stiffness (15.9+2.7N/mm vs. 15.8+1.3N/mm, p=0.798 and 16.9+4.3N/mm vs. 17.1+3.6N/mm, p=0.848, respectively) and elongation at failure (4.7+1.1 mm vs. 4.7+1.3 mm, p=0.848 and 4.8+1.5 mm vs. 4.9+0.9 mm, p=0.749, respectively). Conclusions: The BMS technique of microfracture on the tuberosity of the repaired chronic rotator cuff tear promotes the dynamic tendon healing with significant ultimate force to failure and apparent microscopic findings.

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.

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