Tension Level during Preconditioning Influences Hamstring Tendon Graft Properties

Elias, John J.; Kilambi, Srianjana; Ciccone, William J.

doi:10.1177/0363546508327561

Cited by 29 publications

(42 citation statements)

References 23 publications

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“…However, the G4 is useful in cases of partial ACL rupture where it can augment the native ligament . It could be used in cases of isolated anteromedial bundle tears . It would be strong enough while also reducing the risk of impingement in the notch because of its smaller volume .…”

Section: Resultsmentioning

confidence: 99%

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Biomechanical study of ACL reconstruction grafts

Pailhé¹,

Cavaignac²,

Murgier³

et al. 2015

Journal Orthopaedic Research

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There are no published studies describing the strength quadrupled gracilis tendon alone and quadrupled semitendinosus tendon alone in the configuration used for anterior cruciate ligament (ACL) reconstruction. The primary objective was to compare the mechanical properties of grafts used for ACL reconstruction during a tensile failure test. The secondary objective was to evaluate the effect of uniform suturing on graft strength. Fifteen pairs of knees were used. The mechanical properties of five types of ACL grafts were evaluated: patellar tendon (PT), sutured patellar tendon (sPT), both hamstring tendons (GST4), quadrupled semitendinosus (ST4), and quadrupled gracilis (G4). Validated methods were used to perform the tensile tests to failure and to record the results. Student's t-test was used to compare the various samples. The maximum load to failure was 630.8N (AE 239.1) for the ST4, 473.5N (AE 176.9) for the GST4, 413.3N (AE 120.4) for the sPT, and 416.4N (AE 187.7) for the G4 construct. Only the ST4 had a significantly higher failure load than the other grafts. The sPT had a higher failure load than the PT. The ST4 construct had the highest maximum load to failure of all the ACL graft types in the testing performed here. Uniform suturing of the grafts improved their ability to withstand tensile loading. Keywords: biomechanical; graft; ACL; knee The choice of grafts for anterior cruciate ligament (ACL) reconstruction is not without consequences. One of the advantages of using the hamstring tendonsgracilis (G) and semitendinosus (ST)-is that harvesting these tendons leads to lower morbidity than harvesting a bone-patellar tendon-bone graft. Use of the these tendons provides sufficient strength, limits extensor mechanism weakening and lessens anterior knee pain. 1-7 However, harvesting the G and ST reduces flexion strength and control over internal rotation. 8,9 Recent studies have shown the ST alone can be used as a graft. [10][11][12] However, the ST muscletendon unit controls knee rotation in full extension. 13 Using the gracilis tendon only should reduce the morbidity induced by harvesting both hamstring tendons and preserve the semitendinosus.Zamarra et al. 14 evaluated the potential of using quadrupled gracilis alone or tripled semitendinosus alone to reconstruct the ACL. Authors demonstrated that semitendinosus or gracilis tendon for ACL reconstruction could satisfactorily restore knee kinematics and the in situ forces to those for the intact ACL. Nonetheless, Abramowitch et al, demonstrated differences between the semitendinosus and gracilis tendons in terms of their quasi-static mechanical and non-linear viscoelastic properties. 15 These results were not unexpected given that Kilger et al, in a biomechanical cadaveric study had already showed that gracilis has a higher modulus than the semi tendinosus. 16 Among those studies, several others studies have reported on the strength of each individual tendon [17][18][19] but none has determined graft strength in the configuration used for ACL reco...

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Section: Resultsmentioning

confidence: 99%

“…All the grafts in the current study were preloaded before being pulled to failure. It has been shown that preloading during testing helps to reduce the loss of strength and stiffness that the tendon graft undergoes due to their viscoelastic properties . Tendons are temporarily prestrengthened when they undergo preconditioning .…”

Section: Discussionmentioning

confidence: 99%

Biomechanical study of ACL reconstruction grafts

Pailhé¹,

Cavaignac²,

Murgier³

et al. 2015

Journal Orthopaedic Research

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show abstract

“…Adding tensioning over a transferred tendon is a common practice to achieve ideal function. 13,14 Lieber 13 outlined how surgeons should determine tension to transferred tendons to optimize tendon excursion. Elias et al 14 reported that increasing the tension applied to hamstring tendon grafts during preconditioning decreases the postoperative loss of tension and stiffness due to viscoelasticity.…”

mentioning

confidence: 99%

“…13,14 Lieber 13 outlined how surgeons should determine tension to transferred tendons to optimize tendon excursion. Elias et al 14 reported that increasing the tension applied to hamstring tendon grafts during preconditioning decreases the postoperative loss of tension and stiffness due to viscoelasticity. Nevertheless, no research has been specifically directed to the appropriate tensioning of the tendon segment having direct end-to-end approximation.…”

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confidence: 99%

Effects of Tension Across the Tendon Repair Site on Tendon Gap and Ultimate Strength

Tang

2012

The Journal of Hand Surgery

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“…The authors subjected four commonly used grafts to a cyclic load of 89 N and showed no effect of the preconditioning compared to the no preconditioning condition on the anterior knee laxity. Analyzing the tension levels of quadruple-strand hamstring tendon graft preconditioned at 80 N and 160 N, Elias et al observed that increasing the tension on the graft board could decrease the postoperative loss of tension given by the viscoelastic behavior of the tendons [26]. Regarding the different force values proposed in these previous studies and the results regarding the mechanical graft tissue response, such as the residual anterior knee laxity after tensioning, it appears that simply applying a given force is not the best way of controlling graft tensioning.…”

Section: Discussionmentioning

confidence: 99%

Static tensioning promotes hamstring tendons force relaxation more reliably than cycling tensioning

et al. 2017

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Tension Level during Preconditioning Influences Hamstring Tendon Graft Properties

Abstract: The increased graft tension and stiffness could reduce postoperative knee laxity.

Cited by 29 publications

References 23 publications

Biomechanical study of ACL reconstruction grafts

Biomechanical study of ACL reconstruction grafts

Effects of Tension Across the Tendon Repair Site on Tendon Gap and Ultimate Strength

Static tensioning promotes hamstring tendons force relaxation more reliably than cycling tensioning

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