Purpose
The purpose of this study was to investigate the time-zero biomechanical properties
(stiffness, displacement, and load at failure) of bone-patellar tendon-bone (BTB)
grafts used for anterior cruciate ligament (ACL) reconstruction with and without suture
tape augmentation as a means to determine the potential clinical benefit of this technique.
Methods
Eight juvenile porcine knees underwent ACL reconstruction with a human cadaveric BTB
graft (control). These were compared to 8 juvenile porcine knees that underwent ACL
reconstruction with a BTB graft augmented with suture tape. All knees underwent biomechanical
testing utilizing a dynamic tensile testing machine. Cyclic loading between 50-250N
was performed for 500 cycles at 1 Hz to simulate in vivo ACL loads during the early
rehabilitation phase. The grafts were displaced during load-at-failure tensile testing
at 20 mm/min. Differences in graft displacement, stiffness, and load at failure for
the control and suture tape augmented groups were compared with the Student t-test with a significance level of P < .05.
Results
There was no difference in graft displacement between the 2 groups. A 104% higher
postcyclic stiffness was noted in the augmented group compared to the controls (augmentation:
261 ± 76 N/mm versus control 128 ± 28 N/mm, P = .002). The mean ultimate load at failure was 57% higher in the augmented group
compared to controls (744 ± 219 N vs postcyclic 473 ± 169 N, respectively [P = .015]). There was no difference in mode of failure between the control knees and
those augmented with suture tape, with approximately half failing from pull off of
the tendon from the bone plug and half with pull out of the bone plug from the tunnel.
Conclusion
Independent suture tape augmentation of a BTB ACL reconstruction grafts was associated
with a 104% increase in graft stiffness and a 57% increase in load at failure compared
to nonaugmented BTB grafts.
Clinical Relevance
In vivo suture tape augmentation of a BTB ACL reconstruction increases graft construct
strength and stiffness, which may reduce graft failure in the clinical setting.
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Article info
Publication history
Published online: May 04, 2021
Accepted:
April 22,
2021
Received:
March 5,
2020
Footnotes
See commentary on page 3344
The authors report the following potential conflicts of interest or sources of funding: Arthrex donated cadaveric material and implants to facilitate this project. L.B reports other from Arthrex Inc. J.K. reports non-financial support from Arthrex. M.J.M reports grants from Arthrex Inc and Breg Inc, and other from Schwartz Biomedical and Pacira. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
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© 2021 by the Arthroscopy Association of North America
