Biomechanical Comparison of Quadriceps and 6-Strand Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction

Urchek, Ryan; Karas, Spero G.

doi:10.1177/2325967119879113

Cited by 25 publications

(16 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The quadriceps tendon is one of the graft choices for anterior cruciate ligament reconstruction, as it is almost as strong as the patellar tendon [ 10 ]. Unilateral QTR is a rarely reported trauma with an incidence of only 1.37 cases per 100,000 [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous bilateral quadriceps tendon rupture in a healthy young male: a case report

et al. 2023

View full text Add to dashboard Cite

Background Simultaneous bilateral quadriceps tendon rupture is rare, particularly in young individuals with no prior medical history. We present the case of a young man who presented with bilateral quadriceps tendon rupture. Case presentation A 27-year-old Japanese man missed a step while descending a flight of stairs, stumbled, and became aware of severe pain in both knees. He had no past medical history, but was severely obese, with a body mass index of 43.7 kg/m2 (height 177 cm, weight 137 kg). Five days after injury, he was referred to our hospital for examination and treatment. Bilateral quadriceps tendon rupture was diagnosed based on magnetic resonance imaging, and quadriceps tendon repair with suture anchor was performed on both knees 14 days after injury. The postoperative rehabilitation protocol was to immobilize both knees in extension for 2 weeks, then to gradually proceed with weight-bearing and gait training using hinged knee braces. Both knees obtained a range of motion from 0° to 130° without any extension lag by 3 months postoperatively. One year postoperatively, tenderness was evident at the suture anchor in the right knee. That suture anchor was therefore removed in a second operation, and histological evaluation of the tendon of the right knee revealed no pathological changes. As of 19 months after the primary surgery, the patient showed a range of motion from 0° to 140° in both knees, did not complain of any disability, and had fully returned to normal daily activities. Conclusions We experienced simultaneous bilateral quadriceps tendon rupture in a 27-year-old man with no past medical history other than obesity. Suture anchor repair was performed for both quadriceps tendon ruptures and achieved a favorable postoperative outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Simultaneous bilateral quadriceps tendon rupture in a healthy young male: a case report

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Recently, QT grafts have been more frequently used in ACL reconstruction than ever before [8, 24]; however, surgeons seem to use various fixation techniques in clinical settings and there is no standardized fixation technique [12, 16, 28, 33, 35, 36]. A recent biomechanical study showed that QT grafts have mechanical properties similar to those of six‐strand HT grafts [37]. Another study investigated the effects of different stitching methods and suture diameters on graft fixation of soft‐tissue QT grafts [23].…”

Section: Discussionmentioning

confidence: 99%

Direct suturing quadriceps tendon to a continuous loop with a suspensory button provides biomechanically superior fixation in ACL reconstruction

Kamada

Nagai

Nagamune

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeTo compare the biomechanical strength of different fixation configurations using suspensory buttons in a soft‐tissue quadriceps tendon (QT) grafts in anterior cruciate ligament (ACL) reconstruction. MethodsForty bovine QTs, 6‐cm long and 10‐mm wide, were allocated into four groups with different suture configurations using suspensory buttons (n = 10 in each group): Group A, a baseball suture with a knot tied to the continuous loop with a suspensory button; Group B, same configuration as in Group A but with the knot tied at the opposite end of the baseball suture; Group C, a continuous loop with a suspensory button stitched directly to the QT with simple sutures, and Group D, a baseball suture tied directly to a suspensory button. Biomechanical testing was performed by preloading followed by cyclic loading for 500 cycles between 10 and 100 N. The length of elongation (mm) and maximum load to failure (N) were recorded, and compared among the four groups. ResultsGroup C showed significantly smaller elongation (4.1 mm [95% CI 3.1–5.2]) than Group A (8.2 mm [95% CI 7.0–9.4]), Group B (10.5 mm [95% CI 7.7–13.3]), and Group D (8.5 mm [95% CI 7.0–9.9]) (A–C; P = 0.004, B–C; P = 0.0001, C–D; P = 0.0018). The maximum load to failure in Group C (386 N [95%CI 306–466]) was significantly higher than that in Group A (196 N [95% CI 141–251]), Group B (226 N [95% CI 164–289]), and Group D (212 N [95%CI 171–253]) (A–C; P = 0.0001, B–C; P = 0.0009, C–D; P = 0.0002). No significant differences were observed between Group A, B, and D in terms of elongation and maximum load to failure. ConclusionThe soft‐tissue QT graft fixation configuration stitched directly to a continuous loop with suspensory button using simple sutures exhibits small elongation and high maximum load to failure among the four configurations. Regarding clinical relevance, direct suturing of the soft‐tissue QT to a continuous loop with a suspensory button may be advantageous for femoral fixation in ACL reconstruction from a biomechanical perspective, and warrant future development of a novel fixation device using this principle.

show abstract

“…All loading was performed at 10 mm/min, which is on the same order of magnitude of previous studies that have examined the structural properties of graft fixation techniques. 6 , 24 , 25 , 33 Grafts underwent preloading to 3 N to remove laxity within the system while allowing for analysis of structural properties within the toe region during biomechanical testing. Preconditioning was performed for 20 cycles between 3 and 80 N based on normal ACL graft tension in vivo.…”

Section: Methodsmentioning

confidence: 99%

Continuous-Loop Tape Technique Has Greater Stiffness and Less Elongation Compared With Tied-Suture Fixation of Full-Thickness All–Soft Tissue Quadriceps Tendon Autografts

Gibbs

Winkler

Tisherman

et al. 2021

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Many graft fixation techniques are utilized for full-thickness soft tissue quadriceps tendon autografts during anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the tensile properties of all–soft tissue quadriceps tendon graft fixation using a tied-suture versus continuous-loop tape technique. It was hypothesized that the continuous-loop tape technique would have less cyclic elongation and greater ultimate load to failure and stiffness compared with a commonly used tied-suture technique. Study Design: Controlled laboratory study. Methods: Sixteen fresh-frozen human knee specimens were used to harvest a full-thickness all–soft tissue quadriceps tendon graft; half were secured using a Krackow suture technique with 2 braided sutures, and half were secured using a continuous-loop tape suspensory fixation button with a rip-stop stitch. Cyclic and permanent elongation, toe- and linear-region stiffness, and ultimate load were determined. Statistical analysis was performed at P <.05. Results: The tied-suture fixation group demonstrated significantly higher permanent elongation (11.7 ± 3.6 vs 4.2 ± 1.0 mm, P < .001) and cyclic elongation (5.9 ± 1.3 vs 2.0 ± 0.4 mm, P < .001) compared with the continuous-loop tape fixation group. There was a significantly higher linear-region stiffness with continuous-loop tape fixation compared with tied-suture fixation (98.8 ± 12.7 vs 85.5 ± 7.5 N/mm, P = .022). No significant difference in ultimate load between groups (517.1 ± 149.2 vs 465.6 ± 64.6 N) was found. The mode of failure was tendon pull-through for the continuous-loop tape group and suture breakage in the tied-suture group ( P < .001). Conclusion: Continuous-loop tape fixation is superior to tied-suture fixation in regard to elongation and stiffness for all–soft tissue quadriceps tendon grafts, but there was no significant difference in ultimate load. Clinical Relevance: Continuous-loop tape fixation of all–soft tissue quadriceps tendon grafts for ACLR is a valid technique with superior tensile properties.

show abstract

Biomechanical Comparison of Quadriceps and 6-Strand Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction

Cited by 25 publications

References 27 publications

Simultaneous bilateral quadriceps tendon rupture in a healthy young male: a case report

Simultaneous bilateral quadriceps tendon rupture in a healthy young male: a case report

Direct suturing quadriceps tendon to a continuous loop with a suspensory button provides biomechanically superior fixation in ACL reconstruction

Continuous-Loop Tape Technique Has Greater Stiffness and Less Elongation Compared With Tied-Suture Fixation of Full-Thickness All–Soft Tissue Quadriceps Tendon Autografts

Contact Info

Product

Resources

About