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

Abstract

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.

Regarding “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”

“…We are writing this letter in reference to the article "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," which appeared in Arthroscopy, Sports Medicine, and Rehabilitation. 1 As coauthors of a biomechanical study published on the use of suture tape augmentation for anterior cruciate ligament (ACL) repair, we feel that it is important to point out some critical methodologic flaws in this study that compromise the authors' stated conclusions.…”

“…Full ICMJE author disclosure forms are available for this article online, as supplementary material. We thank the Editor for the opportunity to respond to the letter by Smith et al 1 regarding our recent article "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," which appeared in Arthroscopy, Sports Medicine, and Rehabilitation. 2 Our biomechanical understanding of anterior cruciate ligament (ACL) repair has been tremendously advanced by leaders in the field, including the authors of the letter.…”

“…At the time, we felt that the cortical anchor-based ACL repair would provide more reproducible tensioning ability compared with tying knots. As Smith et al 1 astutely mention in their letter, potential issues with our method of extracortical femoral fixation include suture-cutting effects around bony corners, particularly in cadaveric bone. The reader should be aware of the distinct possibility that our choice of femoral fixation may impact our ability to assess the effect of IB on ACL repair.…”