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

Muench, Lukas N.; Berthold, Daniel P.; Archambault, Simon; Slater, Maria; Mehl, Julian; Obopilwe, Elifho; Cote, Mark P.; Arciero, Robert A.; Chahla, Jorge; Pace, J. Lee

doi:10.1016/j.knee.2021.09.003

Cited by 14 publications

(8 citation statements)

References 40 publications

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“…While numerous augmentation techniques have been described in ACL reconstruction literature, all rely on either independent suture anchor tibial placement or individually tensioned suspensory fixation. 16 , 17 , 18 Although these techniques have demonstrated short-term success, relying on independent augment tensioning presents inherent risks. By tensioning the suture or tape augment separately from the graft, a tension mismatch may occur, which may consequently overconstrain or underconstrain the knee.…”

Section: Discussionmentioning

confidence: 99%

“… 14 Tape augmentation increases the strength of the graft complex, demonstrating greater load to failure and reduced elongation. 15 However, suture or tape augmentation techniques describe incorporating the suture or tape into a separate post from the ACL graft, such as with tibial anchors 16 or tibial suspensory devices. 17 , 18 These techniques introduce the potential for graft and suture tension mismatch and increase surgical cost due to need for an additional anchor/implant.…”

Section: Introductionmentioning

confidence: 99%

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Postless Tape Augmentation for Anterior Cruciate Ligament (ACL) Reconstruction

Alrabaa¹,

Padaki²,

Kannan³

et al. 2022

Arthroscopy Techniques

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postless Tape Augmentation for Anterior Cruciate Ligament (ACL) Reconstruction

Alrabaa¹,

Padaki²,

Kannan³

et al. 2022

Arthroscopy Techniques

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“…In a systematic review on the effect of fixation methods on clinical outcomes, Speziali et al ( 39 ) reported a failure rate of 17.3% when a cross-pin was used on the femoral side, which is in contrast to 5.8% with suspensory fixation ( 39 ). Suture anchors have also been used as a post fixation, with one cadaveric study demonstrating that suture anchor fixation with suture tape augmentation restored normal knee kinematics ( 40 ). There were no significant differences when compared to traditional BTB reconstruction and suspensory fixation alone.…”

Section: Post Fixationmentioning

confidence: 99%

Biomechanical comparison of anterior cruciate ligament reconstruction fixation methods and implications on clinical outcomes

McDermott¹,

DeFoor²,

Blaber³

et al. 2023

Ann Joint

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Anterior cruciate ligament reconstruction (ACLR) is one of the more common surgeries encountered by orthopaedic surgeons, which has its inherent challenges due to the complex anatomy and biomechanical properties required to reproduce the function and stability of the native ACL. Multiple biomechanical factors from graft choice and tunnel placement to graft tensioning and fixation methods are vital in achieving a successful clinical outcome. Common methods of ACLR graft fixation in both the primary and revision setting are classified into compression/interference, suspensory, or hybrid fixation strategies with multiple adjunct methods of fixation. The individual biomechanical properties of these implants are crucial in facilitating early post-operative rehabilitation, while also withstanding the shear and tensile forces to avoid displacement and early graft failure during graft osseointegration. Implants within these categories include the use of interference screws (IFSs), as well as suspensory fixation with a button, posts, surgical staples, or suture anchors. Outcomes of comparative studies across the various fixation types demonstrate that compression fixation can decrease graft-tunnel motion, tunnel widening, and graft creep, at the risk of damage to the graft by IFSs and graft slippage. Suspensory fixation allows for a minimally invasive approach while allowing similar cortical apposition and biomechanical strength when compared to compression fixation. However, suspensory fixation is criticized for the risk of tunnel widening and increased graft-tunnel motion. Several adjunct fixation methods, including the use of posts, suture-anchors, and staples, offer biomechanical advantages over compression or suspensory fixation methods alone, through a second form of fixation in a second plane of motion. Regardless of the method or implant chosen for fixation, technically secure fixation is paramount to avoid displacement of the graft and allow for appropriate integration of the graft into the bone tunnel. While no single fixation technique has been established as the gold standard, a thorough understanding of the biomechanical advantages and disadvantages of each fixation method can be used to determine the optimal ACLR fixation method through an individualized patient approach.

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“…21,26 In addition to the development of several minimally invasive ACL repair techniques, 5,10,17 biological augmentation enhanced healing rates and implant innovations have contributed to improved clinical outcomes. 15,16,22 Additional mechanical protection using an independent nonabsorbable high-strength suture augmentation along with the ACL suture repair has previously shown promising biomechanical and clinical outcomes, 2,4,6,8,11,14,27 demonstrating its importance for early protection of the repair construct to allow for healing. 19 Adjustable single-cinch cortical button fixation showed optimized time-zero ACL tension, leading to significantly improved stabilization and reduced gap formation with higher ultimate strength when compared with other suture repair techniques with either suture knot tying over a button or suture anchor fixation.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Stabilization and Gap Formation of Adjustable Versus Fixed Primary ACL Repair With Internal Brace: An in Vitro Full-Construct Biomechanical Cadaveric Study

Bachmaier,

Smith,

Hammoud

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: A knotless, tensionable primary anterior cruciate ligament (ACL) repair system preloaded with an internal brace has been released. Currently, there is no biomechanical data on the stabilization and gap formation behavior of the adjustable system when compared with fixed repairs in human ACL tissue. Hypothesis: That knotless adjustable suture repair with an internal brace would provide overall higher construct stability and greater load share on the ACL with less gap formation compared with fixed repair. Study Design: Controlled laboratory study. Methods: Human cadaveric knees were utilized for internal braced ACL repair constructs (each group n = 16). Two fixed groups consisting of a single-cinch loop (SCL), cortical button (SCL group), and knotless suture-anchor (anchor group) were compared with an SCL-adjustable loop device (SCL-ALD) group. Testing was performed at 4 different peak loads (50, 150, 250, 350 N) over 4000 cycles at 0.75 Hz including suture repair preconditioning (10 cycles at 0.5 Hz) for SCL-ALD. Specimens were ultimately pulled to failure with a cut internal brace. The final loading situation of the construct and ACL repair with gap formation and ultimate strength were evaluated. Results: Peak elongation at various peak loads showed a significantly higher ( P < .001) stabilization of SCL-ALD when compared with both fixed groups. There was a significantly higher ( P < .001) load share of SCL-ALD, especially at lower loads (48% of 50 N), and the gap formation remained restricted up to 250 N. With only a little load share on the fixed constructs (<6%) at lower loads (50, 150 N), gap formation in these groups started at a load of 150 N, leading to significantly higher gaps ( P < .001). The ultimate failure load for SCL-ALD and anchor groups was significantly increased ( P < .001) as compared with SCL. The stiffness of SCL-ALD (62.9 ± 10.6 N/mm) was significantly increased ( P < .001). Conclusion: Internal braced knotless adjustable fixation for ACL repair with preconditioning of the suture repaired ligament increased the overall stabilization with higher load share on the ACL and restricted gap formation (<0.5 mm up to 350 N) compared with fixed suture repair. All internal braced repairs restored stability according to native ACL function. Clinical Relevance: Adjustable ACL repair improved the mechanical characteristics and reduced gap formation, but the overall clinical significance on healing remains unclear.

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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

Cited by 14 publications

References 40 publications

Postless Tape Augmentation for Anterior Cruciate Ligament (ACL) Reconstruction

Postless Tape Augmentation for Anterior Cruciate Ligament (ACL) Reconstruction

Biomechanical comparison of anterior cruciate ligament reconstruction fixation methods and implications on clinical outcomes

Stabilization and Gap Formation of Adjustable Versus Fixed Primary ACL Repair With Internal Brace: An in Vitro Full-Construct Biomechanical Cadaveric Study

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