Central-Third Bone–Patellar Tendon–Bone Allografts Demonstrate Superior Biomechanical Failure Characteristics Compared With Hemi–Patellar Tendon Grafts

Yanke, Adam B.; Bell, Rick; Lee, Andrew S.; Shewman, Elizabeth; Wang, Vincent; Bach, Bernard R.

doi:10.1177/0363546513501780

Cited by 30 publications

(21 citation statements)

References 28 publications

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“…The maximum load values in the current study were much lower than published values. The leading studies on this topic reported maximum load values of 1719 N ± 1167.80 (range: 456–4546 N), which is nearly three times higher than reported here . It was also surprising to see that this difference did not apply to the stiffness values, which were consistent with our data.…”

Section: Discussionsupporting

confidence: 90%

“…A tensile test was then performed using a 10 mm/min crosshead speed until the graft failed. This sequence is a standard, validated test protocol . The maximum load at failure (N), elongation at failure (mm) and linear stiffness (N.mm −1 ) were automatically measured by the software during the failure test.…”

Section: Methodsmentioning

confidence: 99%

“…Among those studies, several others studies have reported on the strength of each individual tendon but none has determined graft strength in the configuration used for ACL reconstruction.There are no published values for the strength of a quadrupled gracilis (G4) construct or information on the maximum load that a graft in its surgical configuration can withstand before failing.…”

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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: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

mentioning

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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“…Yanke et al demonstrated that biomechanical failure properties and physical parameters of central-third BPTB grafts are superior to the central portion of a hemi-BPTB graft. 50,51 In addition, while several biomechanical studies have demonstrated a dose-dependent degradation in graft biomechanical properties with increasing doses of irradiation, Yanke et al demonstrated that low-dose (1.0-1.2 Mrad) gamma irradiation decreases BPTB stiffness by 20% but does not affect other failure or cyclic parameters. 52 In light of the comparable clinical failure rate, reduced morbidity, and improved ease of rehabilitation, allograft tissue use has steadily increased in the senior author's practice from 1% of all primary cases in 1986 to 1991 to 23% (1998)(1999)(2000)(2001)(2002)(2003) to 46% (2009-2012) and, most recently, to 53% (2012-2014).…”

Section: Discussionmentioning

confidence: 99%

Tips for Successful Transtibial Anterior Cruciate Ligament Reconstruction

2014

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Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed in orthopedics. While results from ACL reconstruction have been highly successful in restoring knee stability and allowing patients to return to sports, a debate continues as to which technique is best for restoring native anatomy and biomechanics. Some have proposed that a transtibial (TT) technique is not able to restore an ACL graft to the native femoral footprint and have advocated independent drilling of the femoral tunnel. We propose that with careful technique it is possible to reliably and reproducibly place the femoral tunnel in the anatomic femoral footprint using a TT technique with excellent results. We describe this surgical technique in detail and review the literature regarding the debate over TT drilling of the femoral tunnel and describe the senior author's (B.R.B.) experience using this technique.

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“…The authors introduce the reader to the ACL reconstruction graft options, sterilization process and associated clinical and laboratory results. This review gives readers the opportunity to implement to their Yanke et al [35] 2013 Laboratory BPTB 1.0-1.2 Mrad Not reported 10 52 ± 11 There was a significant difference in stiffness between the irradiated vs non-irradiated groups but none found in strain and elongation None 10 BPTB: Bone patella tendon bone.…”

Section: Peer-reviewmentioning

confidence: 98%