Abstract
To compare the effect of independent suture tape reinforcement on the dynamic elongation and stiffness behavior as well as ultimate strength of tripled smaller-diameter and quadrupled soft-tissue grafts for anterior cruciate ligament reconstruction (ACLR) with tibial screw fixation in a biomechanical invitro study. Tripled smaller-diameter (8mm) and quadrupled (9mm) bovine tendon grafts with and without suture tape reinforcement (n= 8 in each group) were tested using femoral suspensory and tibial interference screw fixation. The suture tape was femoral sided and fixed independent from the graft by passing it through the suspensory button and securing the 2 open tibial strands with a secondary interference screw. Dynamic testing was performed in position and force control at 250N and 400N, followed by pull to failure with the mode of failure noted. Dynamic elongation, stiffness, and ultimate strength were analyzed. Tripled constructs showed a significantly worse structural performance than quadrupled constructs at higher loads. Reinforcement of tripled and quadrupled grafts substantially decreased total elongation by 56% (4.54 ± 0.75mm vs 2.01 ± 0.50mm, P < .001) and 39% (3.25 ± 0.49mm vs 1.98 ± 0.51mm, P < .001), respectively, by significantly increasing dynamic stiffness. No statistical significance was found between the reinforced groups. Failure loads of reinforced tripled (1,074 ± 148N vs 829 ± 100N, P= .003) and quadrupled (1,125 ± 157N vs 939 ± 76N, P =.023) grafts were also significantly improved. Independent reinforcement of soft-tissue grafts with suture tape strengthened the performance especially of tripled smaller-diameter grafts for ACLR with tibial screw fixation by significantly improving dynamic elongation at increased stiffness and ultimate strength. Quadrupled reinforced grafts showed no over-constraining and structurally behaved similarly to tripled grafts with reinforcement. Independent reinforcement for ACLR may provide an option for protecting autografts or allografts against irreversible lengthening during the maturation and remodeling phases of healing.
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