Fixation of the graft in reconstruction of the anterior cruciate ligament

Harvey, Edward J.; Thomas, Neil P.; Amis, Andrew A.

doi:10.1302/0301-620x.87b5.15803

Cited by 106 publications

(99 citation statements)

References 92 publications

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“…A reliable soft tissue suture technique is essential for ligament-reconstruction surgery, because adequate fixation allows for rehabilitation programs before completion of biologic fixation in the graft tunnel [1,3,6,13,15]. The whipstitch is a common suture technique for preparing and fixing tendon grafts [14].…”

Section: Introductionmentioning

confidence: 99%

Do Needleless Knots have Similar Strength as the Krackow Suture? An In Vitro Porcine Tendon Study

Hong

Kuo

Yeh

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Numerous needleless techniques for tendon graft fixation that feature several advantages have been reported. However, there are few studies that have compared the holding strength between the needleless techniques (rolling hitch and modified rolling hitch) and traditional suture methods. Questions/purposes To compare the tendon graft-holding strength of the rolling hitch and modified rolling hitch with the Krackow stitch in an in vitro porcine biomechanical model. Methods Thirty fresh-frozen porcine flexor profundus tendons were randomly divided into three groups of 10 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across the needleless tendon-grasping techniques and the Krackow stitch. All suture configurations were completed with a braided nonabsorbable suture. Each tendon was pretensioned to 100 N for three cycles, cyclically loaded from 50 to 200 N for 200 cycles, and then finally loaded to failure. Elongation, load to failure, and mode of failure were recorded for each specimen.

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Section: Introductionmentioning

confidence: 99%

Do Needleless Knots have Similar Strength as the Krackow Suture? An In Vitro Porcine Tendon Study

Hong

Kuo

Yeh

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Graft fixation acts as the primary graft stabiliser, providing stiffness to the graft construct and facilitating the incorporation of the graft into the bone tunnel (Beynnon et al, 2005;Chalmers et al, 2013;Hapa & Barber, 2009;Harvey, Thomas, & Amis, 2005;Schindler, 2012;van Eck et al, 2010). An effective fixation method must minimise tunnel widening while providing adequate strength to allow early knee ROM, early weight bearing and enabling the commencement of rehabilitation (Brand, Weiler, Caborn, Brown, & Johnson, 2000;Hapa & Barber, 2009;Harvey et al, 2005).…”

Section: Graft Fixationmentioning

confidence: 99%

“…An effective fixation method must minimise tunnel widening while providing adequate strength to allow early knee ROM, early weight bearing and enabling the commencement of rehabilitation (Brand, Weiler, Caborn, Brown, & Johnson, 2000;Hapa & Barber, 2009;Harvey et al, 2005). The two methods available are direct fixation (the device directly compresses the graft against the bone e.g.…”

Section: Graft Fixationmentioning

confidence: 99%

“…cortical suspension devices). Selection is dependent on graft type, bone density, the fixation site and surgeon preference (Brand et al, 2000;Hapa & Barber, 2009;Harvey et al, 2005).…”

Section: Graft Fixationmentioning

confidence: 99%

“…Direct fixation of the BPTB and STG autografts with a metal or bioabsorbable interference screw has demonstrated excellent long-term outcomes in ACLR in both the tibial and femoral tunnels (Gorschewsky, Stapf, Geiser, Geitner, & Neumann, 2007;Hapa & Barber, 2009;Harvey et al, 2005). The combination of sufficient strength and stiffness, ability to limit slippage and ease of insertion has seen the interference screw widely used (Gorschewsky et al, 2007;Hapa & Barber, 2009;Harvey et al, 2005).…”

Section: Graft Fixationmentioning

confidence: 99%

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Graft tensioning in anterior cruciate ligament reconstruction

Kirwan¹

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BackgroundAnterior cruciate ligament reconstruction (ACLR) is an effective procedure for restoring stability and function. Being a technically demanding procedure, patient outcomes are highly dependent on numerous surgical factors, which are critical for success. The application of tension to the graft prior to tibial fixation is one such factor and is considered essential for the restoration of joint stability, normal knee biomechanics, graft revascularisation and patient function. In applying tension, a key factor is the amount of force applied to the graft. However, the method of applying the tension, position of the knee during tensioning, properties of the graft material, tunnel placement and graft fixation device can all influence the effect that graft tension has on outcomes. Despite the reported importance of graft tension there has been limited empirical evidence defining the best tensioning practice for restoring patient outcome post ACLR. AimsThe goal of this program of research was to explore the effect that different aspects of graft tensioning has on patient function post ACLR. To address the aims of the thesis, three studies were conducted. The first study was a systematic review aimed at examining if a particular amount of tension results in better functional outcomes post ACLR. The second study aimed to compare the effect of two methods of applying graft tension on patient function post ACLR. The study used a prospective randomised controlled trial to compare manual tensioning with the use of a tensioning device. The third study aimed to define current graft tensioning practices and explore the factors that influence surgical decision making. A national survey of Australian orthopaedic surgeons was conducted to achieve the aims of the study. ResultsThe systematic review (study one) revealed that a medium graft tension of 79N to 90N produced the least side-to-side difference (STSD) in anterior posterior (AP) tibial translation as measured by a KT-1000 when compared to tensions <79 or >90N. However, the heterogeneous use of functional outcomes inhibited the ability to draw conclusions on other patient specific functional outcomes.Furthermore, the review highlighted the lack of high quality studies, which also failed to discuss other aspects of graft tension such as the method of applying tension.iii Building on the findings of study one, the second study undertook a RCT to compare the functional outcomes of applying 80N of force with a tensioning device (TD) (n=10) to a manual tensioning method (MT) (n=13) using an estimated force described as a sustained maximum one handed pull.Patients were assessed at pre-surgery and two weeks, three months, six months and 12 months post Based on the findings of study one, tensioning between 79N and 90N appeared to improve the restoration of joint stability, when compared to higher and lower tensions. However, no effect on patient function within 24 months post surgery was apparent. Furthermore, study two observed that tension did not appear to have an...

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Biomaterials that Regulate Growth Factor Activity via Bioinspired Interactions

Hudalla

Murphy

2011

Adv Funct Materials

144

123

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Growth factor activity is localized within the natural extracellular matrix (ECM) by specific non-covalent interactions with core ECM biomolecules, such as proteins and proteoglycans. Recently, these interactions have inspired us and others to develop synthetic biomaterials that can non-covalently regulate growth factor activity for tissue engineering applications. For example, biomaterials covalently or non-covalently modified with heparin glycosaminoglycans can augment growth factor release strategies. In addition, recent studies demonstrate that biomaterials modified with heparin-binding peptides can sequester cell-secreted heparin proteoglycans and, in turn, sequester growth factors and regulate stem cell behavior. Another set of studies show that modular versions of growth factor molecules can be designed to interact with specific components of natural and synthetic ECMs, including collagen and hydroxyapatite. In addition, layer-by-layer assemblies of GAGs and other natural polyelectrolytes retain growth factors at a cell-material interface via specific non-covalent interactions. This review will detail the various bioinspired strategies being used to non-covalently localize growth factor activity within biomaterials, and will highlight in vivo examples of the efficacy of these materials to promote tissue regeneration.

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Fixation of the graft in reconstruction of the anterior cruciate ligament

Cited by 106 publications

References 92 publications

Do Needleless Knots have Similar Strength as the Krackow Suture? An In Vitro Porcine Tendon Study

Do Needleless Knots have Similar Strength as the Krackow Suture? An In Vitro Porcine Tendon Study

Graft tensioning in anterior cruciate ligament reconstruction

Biomaterials that Regulate Growth Factor Activity via Bioinspired Interactions

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