Abstract

We introduce a new approach for a continuous loop tendon-graft preparation, benchmarking it against established graft preparation techniques widely used in conjunction with non-adjustable interference screw fixation. A four-strand bovine tendon graft was prepared using the following graft preparation techniques: standard graft using the baseball stitch technique (M-tech group); continuous loop graft using the GraftLinkTM technique (Arthrex-tech group); continuous loop graft using the Kessler anastomosis technique (Kessler-tech group); and continuous loop graft using a Double-Z anastomosis technique (Double Z-tech group). Each group of eight specimens underwent cyclic loading followed by a load-to-failure test. The M–technique yielded a smaller graft diameter (8.4 ± 0.5 mm) compared to the statistically equivalent diameters of the three continuous loop techniques (8.9 ± 0.6 mm of Arthrex-tech group, 9.1 ± 0.4 mm of Kessler-tech group and 9.2 ± 0.6 mm of Double Z-Tech group). The continuous loop grafts formed by the Double Z-Technique showed outstanding performance among the tested techniques in terms of ultimate failure load (982 ± 121 N) and cyclic elongation (3.7 ± 1.0 mm). There was no significant difference between the four groups in cyclic stiffness. Of the assessed techniques, the Arthrex technique resulted in the lowest ultimate elongation (2.0 ± 0.7 mm), followed by the Double Z-tech (4.5 ± 1.8 mm), the M-tech (5.2 ± 3.9 mm), and the Kessler-tech (5.3 ± 2.4 mm). The Arthrex-tech group (5.98 ± 0.38 min) displayed the shortest graft preparation time, followed by the M-Tech (7.94 ± 0.58 min), Kessler-tech (9.03 ± 0.39 min) and Double Z-Tech (13.29 ± 1.14 min). Double Z-Tech can improve the construct of continuous loop tendon graft with regard to mechanical performance.

Highlights

  • We introduce a new approach for a continuous loop tendon-graft preparation, benchmarking it against established graft preparation techniques widely used in conjunction with non-adjustable interference screw fixation

  • We compared a frequently applied hamstring graft preparation technique used for tibial adjustable length suspensory graft fixation[7] (Arthrex-Tech: GraftLinkTM, Arthrex, Naples, FL) to a conventional M-configuration technique (M-Tech) used in tibial interference screw fixation

  • The second hypothesis was that a graft using Kessler-tech or Double Z-Tech can improve the construct of continuous loop tendon graft with regard to mechanical performance

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Summary

Introduction

We introduce a new approach for a continuous loop tendon-graft preparation, benchmarking it against established graft preparation techniques widely used in conjunction with non-adjustable interference screw fixation. Mainstream ACLR techniques utilize autogenous lower limb tendon grafts (i.e. hamstring tendons, quadriceps tendon) and bone patellar tendon bone (BPTB) grafts with tendon grafts being the most common[4,5] Fixation with these techniques is usually achieved with suspensory or interference screw fixation with suspensory fixation being preferred by many surgeons[6]. Whereas adjustable loop fixation devices may provide sufficient fixation strength and rigidity the biomechanical behavior of continuous double-loop tendon grafts has not been reported In this biomechanical study, we compared a frequently applied hamstring graft preparation technique used for tibial adjustable length suspensory graft fixation[7] (Arthrex-Tech: GraftLinkTM, Arthrex, Naples, FL) to a conventional M-configuration technique (M-Tech) used in tibial interference screw fixation. The second hypothesis was that a graft using Kessler-tech or Double Z-Tech can improve the construct of continuous loop tendon graft with regard to mechanical performance

Methods
Results
Conclusion

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