Load sharing in augmented anterior cruciate ligament repair: a mathematical analysis based on in vitro measurements

Seitz, H.; Wielke, B.; Schlenz, Ingrid; Pichl, W.; Vécsei, V.

doi:10.1016/s0268-0033(96)00037-x

Cited by 9 publications

(5 citation statements)

References 15 publications

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“… 6 , 21 , 22 Van der List and DiFelice 7 reported that cadaveric ACL repairs with suture button and suture anchor fixation had a mean load to failure of 243 N, which is well over the minimum of 60 N necessary for early range of motion. 23 Bachmaier et al. 15 showed ultimate load-to-failure values of over 800 N in porcine specimens with internally braced ACL repairs with button fixation and over 600 N in internally braced repairs with suture anchor fixation, which are more in line with the load to failure reported in our study.…”

Section: Discussionsupporting

confidence: 89%

Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study

Qin

Kahn

Amirouche

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose The purpose of our pilot study was to assess the effect of augmenting anterior cruciate ligament (ACL) repair with suture tape on biomechanical parameters including anterior tibial translation, gap formation, and load to failure. Methods Ten fresh-frozen nonpaired cadaveric knees were dissected, and baseline anterior-posterior stability of both ACL-intact and -deficient knees was obtained. The specimens were randomized to undergo ACL repair either with or without suture tape reinforcement, and anterior tibial translation, as well as gap formation, was measured after cyclic loading. Finally, all specimens were subjected to a single pullout force to determine maximum load to failure. We performed t test analysis to compare means between groups, and significance was defined as P < .05. Results On t test analysis, no statistically significant difference was found regarding anterior tibial translation between the ACL-intact group and either repair group or between the repair group without suture tape augmentation and the repair group with suture tape augmentation. No significant difference in gap formation was detected between the repair groups with and without suture tape augmentation at 100 cycles (1.25 mm vs 1.02 mm, P = .6), 250 cycles (2.87 mm vs 2.12 mm, P = .3), and 500 cycles (4.5 mm vs 4.55 mm, P = .5). The average load to failure of the repairs without suture tape augmentation was not significantly different from that of the repairs with suture tape augmentation (725.9 N vs 725.7 N, P = .99). Conclusions In this pilot study, we did not identify a difference between ACL repairs with and without suture tape augmentation regarding anterior tibial translation, gap formation, or maximum load to failure. Clinical Relevance Treatment of ACL tears with primary ACL repair is a highly debated topic, and studies such as this study to further our understanding of the biomechanical properties of augmented ACL repairs are important for surgeons when deciding the best treatments for their patients.

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Section: Discussionsupporting

confidence: 89%

Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study

Qin

Kahn

Amirouche

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…The CLS-ALD time-zero preload was chosen as the representative load-carrying capacity to protect the ACL during the first few weeks after repair. 34 Knot tying of the ALD shortening strands was performed after preconditioning (point c ). Finally, tibial-sided fixation of the internal brace was performed by tying 4 half-hitch knots over a button (TightRope ABS; Arthrex) before dynamic testing.…”

Section: Methodsmentioning

confidence: 99%

Treatment of Acute Proximal Anterior Cruciate Ligament Tears—Part 2: The Role of Internal Bracing on Gap Formation and Stabilization of Repair Techniques

Bachmaier

DiFelice

Sonnery‐Cottet

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The latest biomechanical studies on some form of internal bracing have shown improved stabilization for anterior cruciate ligament (ACL) repair, but gap formation and load-sharing function have not yet been reported. Hypothesis: Internal bracing of an adjustable ACL repair construct provides improved stabilization with reduced gap formation and higher residual loading on the ACL. Study Design: Controlled laboratory study. Methods: Internally braced ACL repair constructs with single– and double–cinch loop (CL) cortical buttons, a knotless suture anchor, and a single-CL cortical button with adjustable loop fixation (CLS-ALD) were tested (n = 20 each) in a porcine model at 4 different loads (n = 5 each) over 4000 cycles at 0.75 Hz (n = 80 total). The CLS-ALD technique allowed for additional preconditioning (10 cycles at 0.5 Hz). Test results of the isolated internal brace groups served as a baseline for comparison. Lastly, specimens were pulled to failure (50 mm/min) with a cut internal brace. Final loading and gap formation on the ACL repair construct as well as ultimate strength were analyzed. Results: A statistical significance for peak loads over peak elongation was found between the CLS-ALD and all other reinforced groups (analysis of covariance, P < .001). Accordingly, the adjustable repair technique showed improved load-bearing capability with the internal brace compared with all other fixed repair groups and revealed significantly higher loads than the knotted single-CL group. Also, significantly reduced gap formation was found for the CLS-ALD compared with all other groups ( P < .001), with no gap formation up to 150 N with a final gap of 0.85 ± 0.31 mm at 350 N. A significantly higher ultimate failure load (866.2 ± 104.0 N; P < .001) was found for the button-fixed internal brace group compared with all other groups. Conclusion: Internal bracing had a crucial role in improving the stabilization potential of ACL repair at loads occurring during normal daily activity. The added strength of the internal brace allowed for reducing peak loads on the ACL repair construct as well as restricting gap formation to below 3 mm at loads up to 350 N. Clinical Relevance: Improvements in the mechanical characteristics of current ACL repair techniques that enable reduced gap formation and allow for early range of motion and accelerated rehabilitation may strengthen the self-healing response with the formation of stable scar tissue.

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“…Both of the augmented groups were killed after 6 months, because it takes an ACL at least 4 months to heal 29. The group with the autograft was killed after 12 months, because the healing process of a patellar tendon graft including remodeling takes at least 12 months 30.…”

Section: Methodsmentioning

confidence: 99%

Biological response to a new composite polymer augmentation device used for cruciate ligament reconstruction

et al. 2005

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A resorbable composite augmentation cord braided of poly(L-lactide) and poly(L-lactide-co-glycolide) fibers was designed for the temporary protection of repaired cruciate ligaments. This study examined the biocompatibility of the new device and the influence of augmentation duration on ligament healing in a sheep model. The anterior cruciate ligament (ACL) was cut close to the femoral insertion and reinserted with sutures. The repaired ACLs were augmented with the slowly degrading new composite cord and alternatively with a faster degrading polydioxanone cord (PDS). A tendon graft group (gold standard) served as control. Histological evaluation and biomechanical testing were performed after 6 months. The composite cord showed no signs of degradation, whereas the PDS was intra-articularly resorbed. Both devices showed only minor foreign body reactions, proving their good biocompatibility. However, 9 of 11 composite cords had ruptured too early because of fatigue at the bone tunnel entrances. All operated knees were less stable than the nonoperated collateral joints. Knees equipped with the composite cord showed the largest anterior instabilities, whereas the PDS-augmented group exhibited in some cases knee instabilities comparable with that of the tendon group. A positive effect of a longer mechanical protection by a slowly degrading augmentation could not yet be shown. The fatigue strength of the device still needs improvement.

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Load sharing in augmented anterior cruciate ligament repair: a mathematical analysis based on in vitro measurements

Cited by 9 publications

References 15 publications

Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study

Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study

Treatment of Acute Proximal Anterior Cruciate Ligament Tears—Part 2: The Role of Internal Bracing on Gap Formation and Stabilization of Repair Techniques

Biological response to a new composite polymer augmentation device used for cruciate ligament reconstruction

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