Abstract
The aim of this study was to measure and compare the biomechanical properties of two different graft link preparation techniques for anterior cruciate ligament reconstruction. We hypothesised that there would be differences in elongation, load at failure and failure mode due to the different graft link preparation techniques. Thirty fresh-frozen anatomical specimen knees were used. Both tendons (semitendinosus and gracilis) were harvested and randomly assigned to two groups. Graft links prepared with a continuous loop technique were allocated to group 1, whereas those prepared with a buried-knot technique were allocated to group 2. The mechanical properties of both techniques were measured. A mean load to failure of 731 N and an overall graft elongation of 6 mm was found in the continuous loop group. In the buried-knot group, a higher load to failure (848 N) and a lower mean overall elongation (5 mm) was found. The buried-knot technique showed better results with significantly higher load to failure and significantly less elongation compared to the continuous loop technique. It is essential in clinical practice to choose the most accurate technique for graft link preparation to ensure graft stability, especially in the early phase of recovery.
Highlights
Anterior cruciate ligament – reconstruction (ACL-R), utilizing autologous hamstring tendons, has become one of the most frequently performed orthopaedic procedures[1]
There were differences found in the overall elongation with the buried-knot technique showing a significantly lower elongation rate (p = 0.045)
With regard to measured stiffness there was no significant difference found (p = 0.4631), the continuous loop technique presented with better values regarding stiffness (Fig. 7)
Summary
Anterior cruciate ligament – reconstruction (ACL-R), utilizing autologous hamstring tendons, has become one of the most frequently performed orthopaedic procedures[1]. The anterior cruciate ligament (ACL) is exposed to forces of approximately 156 Newton (N) to 170 N, this can increase to 448 N by going downstairs[10,11] and up to 700 N during stumbling, which can cause graft failure in an early stage after reconstruction. These forces need to be considered when using different graft link preparation techniques. The graft link preparation using more sutures through the tendon construct will result in a more stable graft with regards to tendon strength and elongation
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