Abstract:Aims Options for the treatment of intra-articular ligament injuries are limited, and insufficient ligament reconstruction can cause painful joint instability, loss of function, and progressive development of degenerative arthritis. This study aimed to assess the capability of a biologically enhanced matrix material for ligament reconstruction to withstand tensile forces within the joint and enhance ligament regeneration needed to regain joint function. Materials and Methods A total of 18 New Zealand rabbits un… Show more
“…Recent research showed in histologic analysis that there is no negative effect on bone tunnel healing or a prolonged inflammation period by the use of FiberTape. 23 Furthermore, the biocompatibility of the FiberTape was confirmed as having no synovial reactions, no cartilage damage, or other functional consequences. 24 We subsequently confirmed these findings macroscopically when we performed re-arthroscopies (see Fig 18 ).…”
Section: Discussionmentioning
confidence: 93%
“…There are many studies showing the beneficial biomechanical effect of FiberTape use in ACL repair as well as reconstruction. 19 , 23 Fig 18 Left knee with patient in supine position. Diagnostic Arthroscopy one year after ACL reconstruction shows intact ACL graft (green star) with incorporated FiberTape (blue arrow) and an intact synovial sheath.…”
Literature concerning anterior cruciate ligament (ACL) reconstruction has increased in both scope and sophistication during the last decades. Heretofore, the principle focus has been on graft choice comparisons, the appropriate handling of co-injuries such as meniscal tears, cartilage lesions, as well as extra-articular ligament injuries. Despite the accumulated knowledge, there is still a lack of clarity concerning a therapy algorithm for different rupture types. With different consequences in therapy strategy, rupture types were differentiated as (1) subsynovial ACL tears/stretch injury and proximal avulsion tears, (2) single-bundle tear (anteromedial/posterolateral), and (3) total ACL rupture. The article presented here provides an overview of recommended operative therapy strategies for different rupture types of the ACL. Within the past decade, advances in arthroscopic technology coupled with rigorous scientific inquiry have resulted in significantly improved treatment options. With these developments in mind, ACL surgery and postoperative therapy can and should be performed in a manner befitting the patient's individual circumstances. Furthermore, intra- and postoperative suggestions including vancomycin graft-coating, as well as an accelerated “Early Active Rehabilitation” program, including early active physiotherapy without postoperative bracing, as well as additional postoperative extracorporeal shock-wave therapy are recommended.
“…Recent research showed in histologic analysis that there is no negative effect on bone tunnel healing or a prolonged inflammation period by the use of FiberTape. 23 Furthermore, the biocompatibility of the FiberTape was confirmed as having no synovial reactions, no cartilage damage, or other functional consequences. 24 We subsequently confirmed these findings macroscopically when we performed re-arthroscopies (see Fig 18 ).…”
Section: Discussionmentioning
confidence: 93%
“…There are many studies showing the beneficial biomechanical effect of FiberTape use in ACL repair as well as reconstruction. 19 , 23 Fig 18 Left knee with patient in supine position. Diagnostic Arthroscopy one year after ACL reconstruction shows intact ACL graft (green star) with incorporated FiberTape (blue arrow) and an intact synovial sheath.…”
Literature concerning anterior cruciate ligament (ACL) reconstruction has increased in both scope and sophistication during the last decades. Heretofore, the principle focus has been on graft choice comparisons, the appropriate handling of co-injuries such as meniscal tears, cartilage lesions, as well as extra-articular ligament injuries. Despite the accumulated knowledge, there is still a lack of clarity concerning a therapy algorithm for different rupture types. With different consequences in therapy strategy, rupture types were differentiated as (1) subsynovial ACL tears/stretch injury and proximal avulsion tears, (2) single-bundle tear (anteromedial/posterolateral), and (3) total ACL rupture. The article presented here provides an overview of recommended operative therapy strategies for different rupture types of the ACL. Within the past decade, advances in arthroscopic technology coupled with rigorous scientific inquiry have resulted in significantly improved treatment options. With these developments in mind, ACL surgery and postoperative therapy can and should be performed in a manner befitting the patient's individual circumstances. Furthermore, intra- and postoperative suggestions including vancomycin graft-coating, as well as an accelerated “Early Active Rehabilitation” program, including early active physiotherapy without postoperative bracing, as well as additional postoperative extracorporeal shock-wave therapy are recommended.
“…One study has shown that an internal brace increases the biomechanical performance of intra-articular ligament reconstructions and does not affect bone tunnel healing. 17 Using FiberTape also makes it possible to add a second tibial fixation point on the anteromedial cortex of the tibia with a TightRope ABS device. The advantages and limitations of this surgical technique are listed in Table 2 .…”
We describe a technique for revision anterior cruciate ligament (ACL) surgery using a 15-cm strip of the iliotibial band as a graft and the gracilis tendon if available. An internal brace is added to augment the graft. The graft is passed through the femur by drilling an outside-in tunnel from the isometric point F9 of Krackow toward the ACL's footprint and is then double fixed at the tibia using an interference screw and a cortical button. This technique makes it possible to perform simultaneous ACL reconstruction and lateral tenodesis with a continuous, rigid, good-diameter graft that is pedicled to the Gerdy tubercle. Good rotational control is achieved, and all the factors that contribute to ligamentization are present.
“…Even in vivo animal studies have demonstrated advantages of suture tape constructs over standard sutures. 4 However, a common theme in cadaveric mechanical studies is that failure generally occurs at the tissue interface rather than the suture material or anchor. 3 Thus, although suture material strength is an important component of a repair, the quality and thickness of local tissue must be taken into consideration when determining whether postoperative rehabilitation or return to activities might be adjusted based on repair strength.…”
Section: See Related Article On Page 708mentioning
The viscoelastic properties of suture may impact how soft tissue (such as the shoulder rotator cuff tendons) heals to bone and therefore may impact patient outcomes. Thus, it is logical to use suture material less likely to creep and elongate. Suture tape, in particular, may show superior biomechanical properties compared with standard sutures. However, in cadaveric studies, failure generally occurs at the tissue interface, rather than the suture material (or anchor). Thus, the quality and thickness of local tissue must be taken into consideration when determining postoperative rehabilitation or return to activity. Clinical outcome studies comparing suture materials remain elusive, but there is little reason not to use stronger suture material, and this is an option within the surgeon's control.
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