Effect of Tunnel-Graft Length on the Biomechanics of Anterior Cruciate Ligament-Reconstructed Knees

Zantop, Thore; Ferretti, Mário; Bell, Kevin; Brucker, Peter U.; Gilbertson, Lars G.; Fu, Freddie H.

doi:10.1177/0363546508320572

Cited by 138 publications

(113 citation statements)

References 33 publications

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“…However, Zantop et al showed that the outcome of the ACL reconstruction in goats at 12 weeks was not significantly different from 6 weeks. 43 This supports the conclusion that the outcome with respect to AP laxity and ligament stiffness is not worse or better than the ACL reconstruction in the goat.…”

Section: Discussionsupporting

confidence: 82%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n = 5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n = 5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30°in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1 -8.1 N/mm vs. 41.9 -18.0 N/mm [p > 0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising.

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Section: Discussionsupporting

confidence: 82%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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“…The difference in height between the graft groups might also in part explain the difference in graft diameter [22]. However there are reports suggesting that a shorter graft length inside the tunnels does not lead to lower pull-out strength or more frequent graft incorporation complications [23]. Graft length inside the tunnels might therefore be of less importance than previously thought.…”

Section: Discussionmentioning

confidence: 97%

Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?

Barenius

Webster

McClelland

et al. 2012

International Orthopaedics (SICOT)

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Purpose Hamstring tendon grafts are a popular choice for anterior cruciate ligament (ACL) reconstruction. Typical morbidity reported after hamstring tendon harvest is muscle weakness in flexion, and whilst still a matter for debate, this morbidity may be greater if the gracilis tendon is harvested in addition to the semitendinosus. This study sought to comprehensively compare the outcome of ACL reconstructions in which the semitendinosus was harvested alone (ST group) or with the gracilis (ST/G group). Methods Twenty patients (ten ST, ten ST/G) were assessed with a variety of measures that included subjective scores, function, strength and tibial rotation as measured by gait analysis during a pivoting task. Results Results showed that the graft diameter was significantly larger in the ST group, but there were no other differences between the groups for any other outcome measure. Conclusion Harvesting the gracilis in addition to semitendinosus does not appear to affect either the outcome or graft-related morbidity after hamstring ACL reconstruction.

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“…Also, according to Zantop et al, 11 tendon-bone anchoring occurs only in the first 12 mm of the bone tunnel, and a short graft length (15 mm) does not have a negative correlation with knee kinematics and structural properties. Logan et al, 12 however, suggested that the dimension of the graft may be important because it ultimately determines the surface area of tendon-bone healing.…”

Section: Discussionmentioning

confidence: 95%

Hamstring Graft Biological Preparation for Anterior Cruciate Ligament Reconstruction

Barbosa¹,

Guerra-Pinto²,

Cabeleira³

et al. 2017

Arthroscopy Techniques

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The all-inside anterior cruciate ligament reconstruction (ACLR) success depends on biologic integration of the graft in the bone tunnel. Sutures wrapping the tendon in the bone tunnel may affect tendon-bone healing in shorter bone tunnels. To achieve better graft integration, we propose a variation of the graft link suture technique wherein the graft is linked chain-like to the femoral and tibial TightRope (Arthrex), which increases the tendon-bone contact area by eliminating sutures from the noose of the graft and thus may allow better graft integration.

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Effect of Tunnel-Graft Length on the Biomechanics of Anterior Cruciate Ligament-Reconstructed Knees

Cited by 138 publications

References 33 publications

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?

Hamstring Graft Biological Preparation for Anterior Cruciate Ligament Reconstruction

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