Biomechanical cadaveric comparison of patellar ligament suture protected by a steel cable versus a synthetic cable

Abstract

BackgroundPurpose and hypothesis: Patellar ligament rupture is a rare disabling pathology requiring a surgical ligament suture protected by a frame. The gold standard is the steel cable, but its rigidity and the necessity of a surgical re-intervention for its removal render it unsatisfactory. The objective of this paper is to quantify the mechanical protection provided by the terylene® in comparison with steel.MethodsTwenty-four knees of 12 fresh frozen cadaveric subjects were divided into 2 homogeneous groups (terylene and steel) of 12 knees (mean age = 69.3 years). Proximal ligament repair was performed according to a three-tunnel transosseous reinsertion technique. Mechanical tests were performed in flexion to simulate movement of the knee. The interligament gap and the amplitude angulation of the knee were measured by a system of extensometer and optical goniometer. Mechanical analysis permitted calculation of flexion amplitude for a ligament gap of 1 and 2 mm taking as initial angle the adjusting angle of pretension of the protection frame. Study of deformations of frames was performed. Statistical analysis was performed with a Wilcoxon Mann Whitney test.ResultsThere is no significant difference in protection of the ligament suture between the “terylene” and “steel” groups. Mean flexion amplitudes (mΔF) show no significant differences between the 2 groups for a distension of the suture of 1 mm (m ΔF terylene1 = 4.74 °; mΔF steel1 = 5.91°; p = 0.198) and 2 mm (mΔF terylene2 = 8.71°; mΔF steel2 = 10.41°; p = 0.114). Elastic deformation of terylene was significantly greater than that of steel (p = 0.0004).ConclusionSuture protection of the patellar ligament by a terylene wire is not significantly different from that provided by steel frame. The elastic properties of terylene and absence of a need for re intervention to secure its removal lead us towards its use in acute ruptures of the patellar ligament. The main limits involve the properties of the chain extenders with no contraction/muscle shortening and partial dehydration of tendons and ligaments and the mean age of 69.3 years.Level 5.Electronic supplementary materialThe online version of this article (doi:10.1186/s40634-017-0084-6) contains supplementary material, which is available to authorized users.

High-Strength Suture Tape Augmentation Improves Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

“… 2 Several strategies for augmentation of this technique have been studied, including the use of cerclage wires, figure-8 suture, and hamstring autograft. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 These augmented techniques have demonstrated superior biomechanical properties compared with the Krackow transosseous technique alone, which may facilitate advanced biomechanical stability to support accelerated rehabilitation protocols. 3 , 4 , 5 , 6 , 7 , 8…”

Effect of Poly-L-Lactic Acid Mesh Augmentation on Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

“…1 Several nonabsorbable augments including cerclage wire, figure-of-eight suture, and high-strength suture tape have demonstrated superior biomechanical strength compared with the trans-osseous technique alone. [2][3][4][5][6] Similarly, various autograft tissues have been described as part of potential augmentation strategies. [7][8][9][10][11] However, the role for a biologically active synthetic scaffold to augment patellar tendon repair has not been elucidated.…”

“…1 Several nonabsorbable augments including cerclage wire, figure-of-eight suture, and high-strength suture tape have demonstrated superior biomechanical strength compared with the trans-osseous technique alone. [2][3][4][5][6] Similarly, various autograft tissues have been described as part of potential augmentation strategies. [7][8][9][10][11] However, the role for a biologically active synthetic scaffold to augment patellar tendon repair has not been elucidated.Poly-L-lactic acid (PLLA) is a synthetic biodegradable polymer that has been recognized for its biocompatibility and long-lasting tensile strength in a wide range of Keywords ► patellar ► tendon ► poly-L-lactic acid ► mesh ► cadaveric ► biomechanics…”