Biomechanical Evaluation of Suture Tape Internal Brace Reinforcement of Soft Tissue Allografts for ACL Reconstruction Using a Porcine Model

Wicks, Eric D.; Stack, J.R.; Rezaie, Nima; Zeini, Ibrahim Mamdouh; Osbahr, Daryl C.

doi:10.1177/23259671221091252

Cited by 18 publications

(12 citation statements)

References 43 publications

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“…Laboratory studies have shown the suture tape–augmented graft construct to be biomechanically stronger. 5-7,32,35,47,53 Bachmaier et al 7 showed significantly reduced elongation and higher ultimate failure load without stress shielding the hamstring graft. Wicks et al 53 demonstrated a 33% decrease in cyclic displacement and a 25% increase in yield strength with suture tape reinforcement without increasing graft construct stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…Biomechanical studies have shown that adding suture tape reinforcement to a reconstruction significantly increases the ultimate tensile strength of the construct without stress shielding and reduces graft elongation. 6,7,29,53 This added strength may reduce ACL failure rates, particularly when the graft is most vulnerable. In addition, the greatest biomechanical effect has been demonstrated with small-diameter grafts.…”

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confidence: 99%

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Outcomes of Anterior Cruciate Ligament Reconstruction With Independently Tensioned Suture Tape Augmentation at 5-Year Follow-up

Wilson,

Kennedy,

MacLeod

et al. 2023

Am J Sports Med

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Background: Reconstruction using autograft remains the gold standard surgical treatment for anterior cruciate ligament (ACL) injuries. However, up to 10% to 15% of patients will suffer a graft failure in the future. Cadaveric studies have demonstrated that the addition of suture tape augmentation to ACL autograft constructs can increase graft strength and reduce elongation under cyclical loading. Purpose/Hypothesis: This study aimed to investigate the clinical outcomes and rerupture rates after ACL reconstruction (ACLR) with suture tape augmentation. We hypothesized that augmentation with suture tape would lead to lower rerupture rates. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing primary ACLR using hamstring or patellar tendon autografts augmented with suture tape between 2015 and 2019 were recruited prospectively. Patients with multiligament injuries or a concomitant lateral extra-articular procedure were excluded. Patients were observed in person for 6 months, and patient-reported outcome measures (PROMs) were collected at 2 and 5 years postoperatively. All patients were contacted, and records were reviewed to determine the incidence of graft failure. PROMs collected were as follows: Knee injury and Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR-12), Tegner and Marx activity scores, and visual analog scale for pain (VAS). Results: A total of 97 patients, with a mean age of 34.7 (±13.4) years, were included (76% men; 52 hamstring and 45 patellar tendon grafts). The mean graft diameter was 8 (±1) mm. There was 1 rerupture (1.1%) out of the 90 patients who were contactable at a mean of 5 years postoperatively. Median KOOS scores at 2 years were as follows: Pain, 94; Symptoms, 86; Activities of Daily Living, 99; Sport and Recreation, 82; and Quality of Life, 81. The postoperative scores were significantly higher than the preoperative scores ( P < .001). The VR-12 Physical score improved from 43 preoperatively to 55 at 2 years and remained at 56 at 5 years. The VAS pain, Tegner, and Marx scores were 0, 6, and 9, respectively, at 2 years postoperatively. There was no difference in PROMs between graft types. Conclusion: This study demonstrates encouraging results of suture tape augmentation of autograft ACLR for both hamstring and patellar tendon grafts. The failure rate of 1.1% at a mean follow-up of 5 years is lower than published rates for reconstruction, and PROMs results are satisfactory. The technique is safe to use and may permit a return to the preinjury sporting level with a lower chance of reinjury.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Outcomes of Anterior Cruciate Ligament Reconstruction With Independently Tensioned Suture Tape Augmentation at 5-Year Follow-up

Wilson,

Kennedy,

MacLeod

et al. 2023

Am J Sports Med

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“…The posterior transeptal portal approach allows good visualization of the tibial tunnel preparation and protects the vital neurovascular structures 5 Allograft bone plugs facilitate revision in the onestage procedure 11 Internal brace augmentation protects the graft during the revascularization and remodeling process 12 Backup fixation is essential due to compromised bone stock in revision surgeries 4 Here are our references. Thank you for watching this video.…”

Section: Surgical Techniquesmentioning

confidence: 99%

Revision Posterior Cruciate Ligament Reconstruction Technique

Mouarbes,

Ripoll,

Vari

et al. 2023

Video Journal of Sports Medicine

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Background: Revision posterior cruciate ligament reconstruction (PCLR) is challenging, especially in existing semi-anatomic tunnels, whereas there is an increased risk of overlapping with a new positioned anatomic tunnel. Few cases were published with no consensus regarding the optimal operative technique. Indications: A 22-year-old male patient, with failed PCLR with hamstring autograft in 2020 due to improper tunnels placement, presented for pain and instability of his right knee. Physical examination revealed a positive posterior drawer and reverse Pivot-Shift test, with no varus-valgus or rotational laxity. Radiograph showed no signs of arthritis, normal tibial slope, and normal long-leg standing axis. Magnetic resonance imaging showed rupture of the PCL graft with no meniscal, chondral, or concomitant ligament injuries. Technique Description: We described a single-bundle transtibial technique with a posterior transeptal portal approach to reconstruct the PCL. We started by preparing the allograft with an internal brace augmentation and an adjustable button (Arthrex) placed on the femoral side for cortical fixation. The old semi-anatomical femoral tunnel was drilled and grafted using an allograft bone dowel (Biobank), and a new anatomic femoral tunnel was drilled inside-out. Under direct visualization via posterior transeptal portals, a new anatomic tibial tunnel was drilled posterior to the existing nonanatomic tunnel. Using a shuttle suture, the transplant was passed and fixed by an adjustable button at the femur and by two interference screws and a backup fixation using a Swive-lock anchor at the tibia (Arthrex). Results: Favorable functional and clinical outcomes with improvement of anteroposterior stability. Significant improved side-to-side differences on posterior stress radiography and improved subjective and objective clinical scores. Satisfactory outcomes with 75% of patients returned to preinjury Tegner activity scale level of function. Discussion/Conclusion: The use of the posterior transeptal portals approach protects the vital neurovascular structures and ensures proper PCL tibial tunnel placement by providing direct visualization of the tibial attachment. Allograft bone dowels facilitate PCL revision in a one-stage procedure by filling the existing semi-anatomic tunnels and allowing to drill the new anatomic tunnels without tunnel overlap. The use of the internal brace augmentation strengthens the construct to protect the graft during the revascularization and remodeling process by facilitating tissue ingrowth and incorporation. In revision surgery, backup fixation is encouraged and often essential due to the compromised bone stock. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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“… 11 , 12 The addition of suture or tape to serve as an augment for the ACL graft is easy to perform and does not necessitate a separate open incision. Further, this technique has demonstrated potential in improving both biomechanical 13 and clinical outcomes following ACL reconstruction. 14 Tape augmentation increases the strength of the graft complex, demonstrating greater load to failure and reduced elongation.…”

Section: Introductionmentioning

confidence: 99%