Internal Suture Augmentation Technique to Protect the Anterior Cruciate Ligament Reconstruction Graft

Abstract

The anterior cruciate ligament suture augmentation technique is a method to augment anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendons using a braided ultrahigh–molecular weight polyester or polyethylene suture or suture tape and fixed on both the femoral and tibial sides independent of the graft to act as a backup or secondary stabilizer until complete integration and ligamentization of the graft take place. The technique is proposed to allow early rehabilitation and return to sports after ACLR and may be advantageous in patients with a high body mass index and in cases with small grafts (7 or 7.5 mm in diameter). In such situations the technique is supposed to decrease the risk of reinjury, as well as the degree of postoperative lengthening or stretching of the graft, in the early postoperative avascular phase. We describe graft preparation with the internal suture augmentation technique in arthroscopic ACLR using a cortical button system on the femoral side and a Bio-Interference Screw (Arthrex, Naples, FL) on the tibial side.

All-Inside Arthroscopic Anterior Cruciate Ligament Reconstruction and Internal Brace With Recycling Suture

“…[3][4][5][6][7] In the previous literature, internal brace augmentation was performed by using FiberTape (Arthrex) to protect the ACL graft and could augment the graft with biologic tissue such as amnion, or bone marrow concentrate. [8][9][10]12,13 However, in a cadaveric study, Lai et al 14 showed that suture augmentation also improved the ultimate load to failure and cyclic displacement in ACL grafts. There was also a surgical technique using multiple suture strands to augment ACL which was reported by Kuptniratsaikul et al 15 The suture acts as a structural tie before fully ligamentization of the ACL.…”

“…In the previous literature, internal brace augmentation was performed by using FiberTape (Arthrex) to protect the ACL graft and could augment the graft with biologic tissue such as amnion, or bone marrow concentrate. 8 , 9 , 10 , 12 , 13 However, in a cadaveric study, Lai et al. 14 showed that suture augmentation also improved the ultimate load to failure and cyclic displacement in ACL grafts.…”

“… 5 , 6 , 7 There are techniques that use high-strength sutures to increase the strength of ACL grafts and protect them during the ligamentization period of the graft, such as fiber tape augmentation and internal suture augmentation techniques. 8 , 9 , 10 Here, we propose an AI ACLR technique that uses the shortening limbs from an ACL TightRope (Arthrex, Naples, FL) adjustable button as the internal brace to prevent graft elongation and protect the graft without using additional sutures.…”

Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction With Independent Suture Tape Reinforcement

“… 16 Suture tape augmentation/reinforcement has been performed in an attempt to improve results after primary ACL reconstruction. 10 , 11 , 12 , 13 Interest in augmenting grafts during ACL reconstruction stems from the biomechanical and clinical success of suture augmentation in non-knee-related procedures such as Brostrom repairs 17 and ulnar collateral ligament repairs in the elbow. 18 Promising outcomes have also been seen in conjunction with medial knee injuries 19 , 20 and ACL repairs.…”

“…Recently, in an attempt to improve clinical outcomes, suture tape augmentation/reinforcement ( Internal Brace; Arthrex, Naples, FL) has been described in both hamstring autografts and allografts. 10 , 11 , 12 , 13 The Internal Brace is composed of a FiberTape (Arthrex) suture, an ultrahigh-molecular-weight polyethylene/polyester tape that is collagen coated to increase tissue integration. Purported advantages include protection of the graft during the proliferation, maturation, and ligamentization phases of healing.…”