Abstract

BackgroundWith the developments in the arthroscopic technique, anterior cruciate ligament (ACL) remnant-preserving reconstruction is gradually gaining attention with respect to improving proprioception and enhancing early revascularization of the graft. To evaluate the mechanical pull-out strength of three different methods for remnant-preserving and re-tensioning reconstruction during ACL reconstruction.MethodsTwenty-seven fresh knees from mature pigs were used in this study. Each knee was dissected to isolate the femoral attachment of ACL and cut the attachment. An MTS tensile testing machine with dual-screw fixation clamp with 30° flexion angle was used. The 27 specimens were tested after applying re-tensioning sutures with No. 0 polydioxanone (PDS), using the single stitch (n = 9), loop stitch (n = 9), and triple stitch (n = 9) methods. We measured the mode of failure, defined as (1) ligament failure (longitudinal splitting of the remnant ACL) or (2) suture failure (tearing of the PDS stitch); load-to-failure strength; and stiffness for the three methods. Kruskal-Wallis test and Mann-Whitney U-test were used to compare the variance of load-to-failure strength and stiffness among the three groups.ResultsLigament failure occurred in all cases in the single stitch group and in all but one case in the triple stitch group. Suture failure occurred in all cases in the loop stitch group and in one case in the triple stitch group. The load-to-failure strength was significantly higher with loop stich (91.52 ± 8.19 N) and triple stitch (111.1 ± 18.15 N) than with single stitch (43.79 ± 11.54 N) (p = 0.002). With respect to stiffness, triple stitch (2.50 ± 0.37 N/mm) yielded significantly higher stiffness than the other methods (p = 0.001).ConclusionsThe results suggested that loop stitch or triple stitch would be a better option for increasing the mechanical strength when applying remnant-preserving and re-tensioning reconstruction during ACL reconstruction.

Highlights

  • With the developments in the arthroscopic technique, anterior cruciate ligament (ACL) remnantpreserving reconstruction is gradually gaining attention with respect to improving proprioception and enhancing early revascularization of the graft

  • The results suggested that loop stitch or triple stitch would be a better option for increasing the mechanical strength when applying remnant-preserving and re-tensioning reconstruction during ACL reconstruction

  • Mode of failure Ligament failure occurred in all cases in the single stitch group and in all but one case in the triple stitch group

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Summary

Introduction

With the developments in the arthroscopic technique, anterior cruciate ligament (ACL) remnantpreserving reconstruction is gradually gaining attention with respect to improving proprioception and enhancing early revascularization of the graft. Despite the recent successful outcomes of anterior cruciate ligament (ACL) reconstruction, the failure rate is still 8–25 % [1, 2]. For successful ACL reconstruction, various factors, including graft placement with firm fixation, incorporation, revascularization, and ligamentization, should be considered [2,3,4]. With the developments in the arthroscopic technique, ACL remnant-preserving reconstruction is gradually gaining attention with respect to improving proprioception and enhancing early revascularization of the graft [1, 2, 4, 7]. The clinical results of the remnant-preserving method are still debated [2, 8]

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