Abstract
BackgroundIn anterior cruciate ligament reconstruction, quadrupled semitendinosus (Quad ST) grafts have potential advantages over doubled semitendinosus–gracilis (ST/G) including larger diameter and gracilis preservation, however the ideal tibial fixation method of the resultant shorter Quad ST graft remains elusive if a fixed-loop suspensory fixation device is used on the femur. We investigated whether the tibial fixation biomechanical properties of a Quad ST fixed indirectly with polyethylene terephthalate tape tied over a screw in a full outside-in created tunnel was superior to a ST/G graft fixed with an interference screw.Materials and methodsIn a controlled laboratory study, six cadaveric matched pairs of each construct were subjected to cyclic loading to mimic physiologic loading during rehabilitation. This included preconditioning cycling, cyclic loading to 220 N for 500 cycles, then cyclic loading to 500 N for 500 cycles.ResultsHigh standard deviations across the measured parameters occurred with no significant difference between measured parameters of elongation for the different constructs. Elongation of the Quad-ST construct was greater at 10 and 100 cycles, but not statistically different. Four of the six Quad-ST constructs failed below 100 cycles, compared with two failures below 100 cycles in the ST/G construct. There was a strong correlation between cycles to failure and bone mineral density for the Quad ST-tape constructs.ConclusionsTibial fixation of Quad ST with a tied tape–screw construct in a full-length tunnel was not biomechanically superior to ST/G graft fixed with an interference screw, exhibited greater nonsignificant construct elongation with earlier failure, and was more reliant on bone mineral density.Level of evidenceIn vitro laboratory study.
Highlights
The ideal anterior cruciate ligament reconstruction (ACLR) graft and fixation choice remains elusive, with all common graft options having some disadvantages
Tibial fixation of quadrupled semitendinosus (Quad ST) with a tied tape–screw construct in a full-length tunnel was not biomechanically superior to ST/G graft fixed with an interference screw, exhibited greater nonsignificant construct elongation with earlier failure, and was more reliant on bone mineral density
Hamstring autografts have become more commonly utilized in recent years [1] in some regions, concerns remain over higher failure rates in both registry studies [5] and randomized controlled trials [6] compared with autograft patella tendon grafts
Summary
The ideal anterior cruciate ligament reconstruction (ACLR) graft and fixation choice remains elusive, with all common graft options having some disadvantages. Interference screw and polyethylene braided terephthalate (PET) tape fixation has been promoted as an alternative method for both tibial and femoral fixation of short quadrupled ST grafts, with supportive biomechanical data [14, 22, 23] for methods using partial length inside-out created tunnels, this tape–screw method cannot be utilized with a fixed suspensory fixation loop on the femur. In anterior cruciate ligament reconstruction, quadrupled semitendinosus (Quad ST) grafts have potential advantages over doubled semitendinosus–gracilis (ST/G) including larger diameter and gracilis preservation, the ideal tibial fixation method of the resultant shorter Quad ST graft remains elusive if a fixed-loop suspensory fixation device is used on the femur. We investigated whether the tibial fixation biomechanical properties of a Quad ST fixed indirectly with polyethylene terephthalate tape tied over a screw in a full outside-in created tunnel was superior to a ST/G graft fixed with an interference screw
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