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

Abstract

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.

Biomechanical Stability of Third-Generation Adjustable Suture Loop Devices Versus Continuous Loop Button Device for Cortical Fixation of ACL Tendon Grafts

“…Primary stability of ALB button devices has been assessed in a variety of biomechanical studies with different study protocols. 20 , 36 , 41 First, isolated testing of the implant led to lower elongation and higher load to failure in comparison to in vitro ACLR. 6 , 12 , 19 , 24 , 36 However, the influence of the interface between the implant and the cortical bone or the tendon graft is not considered in isolated implant testing.…”