Purpose
To evaluate the effects of different stitching methods and suture diameters on the
graft fixation of soft tissue human quadriceps tendon grafts for anterior cruciate
ligament (ACL) reconstruction.
Methods
The Krackow locking stitch (K), whipstitch (W), and baseball stitch (B) were combined
with either a 2× no. 2 (#2) or a 1× no. 5 (#5) braided composite suture for graft
fixation of 36 human quadriceps tendons in 6 groups. Biomechanical testing was performed
using a cyclic protocol with loads between 0 and 100 N. The maximum load until failure,
cyclic elongation, and failure mode were recorded.
Results
The highest mean maximum load to failure was observed in the 2 Krackow stitch groups.
The K#2 group had significantly higher load to failure values compared with those
of the W#2 and B#2 groups (K#2, 553 ± 82 N vs W#2, 392 ± 107 N, P = .0349; K#2 vs B#2 366 ± 118 N, P = .0129). The mean cyclic elongation was lowest in the Krackow groups (K#2, 10.59
± 2.63 mm; K#5, 13.66 ± 2.3 mm). The regular failure mode was the rupture of the suture
for the Krackow stitch (8 of 12) and suture pullout for the whipstitch (11 of 12)
and baseball stitch groups (12 of 12).
Conclusions
The double Krackow stitch with no. 2 braided composite suture exhibits a high maximum
load to failure combined with a low amount of elongation in a biomechanical study
for human quadriceps tendon soft tissue graft fixation. Unlike the whipstitch and
the baseball stitch, it can solidly prevent suture pullout.
Clinical Relevance
A safe soft tissue graft fixation technique is especially important for quadriceps
tendon grafts with their laminar anatomical structure and physiologically varying
diameter. Unlike other grafts for ACL replacement, it fully relies on the soft tissue
suture fixation to resist the pullout force.
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Article info
Publication history
Published online: August 09, 2019
Accepted:
May 13,
2019
Received:
January 30,
2019
Footnotes
Philipp A. Michel, M.D., M.Sc., and Christoph Domnick, M.D., are co-first authors and contributed equally to this work.
The authors report the following potential conflicts of interest or sources of funding: M.J.R. receives support from Depuy Smith. M.H. receives support from Medacta, Olympus, DJO, Conmed, and Linvatec. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
See commentary on page 3077
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Anterior Cruciate Ligament Graft Fixation Strength: Do Ultimate Load and Cyclic Deformation Really Matter?ArthroscopyVol. 35Issue 11
- PreviewSurgeons, therapists, and industry are very focused on anterior cruciate ligament graft fixation strength, specifically ultimate load and cyclic deformation. Although many publications have focused on the importance of these values, no significant issues with early graft fixation failure or elongation have been recently been reported. Thus, instead of focusing on the absolute maximum values, it would be more helpful to define a minimum successful fixation strength, as well as determine how to test for physiologic cyclic elongation.
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