Graft For ACL Reconstruction Research Articles

Donor-site morbidity following arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft.

Peroneus longus has proved to be a promising graft for ACL reconstruction due to its high tensile strength, and ease of harvesting. While multiple studies have assessed the functional outcomes of the knee after ACL reconstruction using peroneus longus autograft, we aimed to evaluated donor site morbidity among the Indian population. This was a prospective, longitudinal, descriptive study conducted at a tertiary care hospital. Preoperative AOFAS and Karlsson-Peterson scores were obtained, and patients were followed up after surgery for a period of 6-months using the same scoring systems and strength testing with a hand-held Chatillon MSE-100-M dynamometer. Pedobarographs were done using Diers Pedoscan Plantar Pressure Measurement System on a subset of seven patients. 20 patients participated in the study. Mean AOFAS and Karlsson-Peterson scores pre-operatively were 99.7 ± 1.34 and 98.5 ± 4.62 respectively. On completing 6- months of follow-up these scores were found to be 95.6 ± 9.43 and 88.75 ± 18.42 respectively. Deterioration of mean evertor strength was noted at all follow-ups compared to the opposite side. Static pedobarographs showed significant decreased in total surface area of contact and pressure over the posterior aspect of the operated side by 3-months which improved later at 6-months. Dynamic pedobarographs showed decreased mean average plantar pressure while walking on the operated side and significant increase in mean surface area of contact of the operated side (191.886±22.678 cm2) at 6-months of follow-up compared to the opposite side (184.471 ± 22.218 cm2). Five patients showed deviation of the point of maximum pressure while walking on the operated foot making it lateral to the COP with increased lateral plantar/ medial plantar pressure ratio. While the use of peroneus longus tendon autografts in arthroscopic ACL reconstruction does not seem problematic on short-term subjective assessment, there is objective evidence in keeping with evertor weakness, weakness of first ray plantar flexion and possible ankle instability. Level lll.

Estimation of Diameter of Quadrupled Hamstring Graft for ACL Reconstruction using Pre-operative MRI Measurement as a Predictive Tool.

The diameter of the quadrupled Hamstring graft plays a significant role in the incidence of graft failures for ACL reconstruction. The ability to predict the graft size pre-operatively can prepare the surgeon for alternatives in the event of an inadequate graft diameter. We retrospectively measured the diameter of the Semitendinosus tendon (ST) on the MRI in all patients who underwent arthroscopic ACL reconstruction using quadrupled Semitendinosus as their graft. We also estimated any correlation between various anthropometric data with pre-operative MRI based Cross Sectional Area (CSA) of the Hamstring tendon and final graft diameter in the South Asian population. The patients were included from Jan 2018 - Dec 2020. The minimum CSA of ST to predict an eventual graft diameter of 7.5mm was 10.7mm2. The MRI based cross-sectional area measurement showed moderate correlation with the intra-operative graft diameter obtained. (r=0.62, p<0.001). The intra-class correlation coefficient between the radiologist and the surgeon was 0.82, 95% CI (0.57, 0.92) and a p-value <0.001. Pre-operative MRI can be a useful tool to predict the graft diameter. This coupled with the anthropometric data of the patient can be used as an adjunct to estimate the probable graft diameter. Thus, the surgeon can be better prepared for the surgery and can seek alternate graft options if the graft size is deemed inadequate pre-operatively.

“Trends and beliefs in ACL reconstruction surgery: Indian perspectives”

ObjectivesThe survey aimed to assess trends and beliefs in the management of anterior cruciate ligament reconstruction (ACLR) amongst orthopaedic surgeons in India. MethodsA survey was created and distributed among the various orthopaedic surgeons from India. The questionnaire included brief details of surgeons and their experience, clinical assessment, management strategies and the rehabilitation protocol. Results135 surgeons completed the survey. 35% of them were having experience of more than 12 years. A large number of surgeons were from government academic institutes (35.5%). The most common criteria for deciding about surgery was Clinical evaluation (94.8%). The most common graft choice was hamstring tendon (94%), and suspensory fixation on the femur side and interference screw on the tibial side (80%) is the most common fixation method. Almost two-thirds of surgeons in this survey use bracing to protect ACL graft in the initial phase. ConclusionWe presented the preferences amongst the group of surgeons on the management of ACL injuries. Hamstring tendon graft remains the most preferred graft for ACL reconstruction. Further, the suspensory loop on the femoral side and interference screw on the tibial side are the preferred fixation method. This group of surgeons is conservative in terms of the timing of surgeries and post-operative bracing. Level of evidence Level V, Expert Opinion.

Analysis of Postural Control following Anterior Cruciate Ligament Reconstruction with Ipsilateral Peroneus Longus Tendon Graft.

Harvesting peroneus longus for ACL reconstruction is thought to create ankle instability which could add to postural instability from an ACL injury. This apprehension prevents its use as a graft of primary choice for many surgeons. To date, there is no evidence available describing changes in postural control after its use in ACL reconstruction. The purpose of the study was to analyse the changes in postural control in the form of static and dynamic body balance after ACL reconstruction with Peroneus Longus Tendon Graft and compare it with the unaffected limb at different time intervals. Thirty-one participants with ACL injury were selected and subjected to an assessment of static and dynamic balance before and after ACL reconstruction using the HUMAC balance system. Outcome measures for Centre of Pressure (COP) assessment were average velocity, path length, stability score, and time on target. Comparison of scores was done pre-operatively as well as at three- and six-months post-reconstruction with Peroneus longus tendon graft. Static balance of the affected limb showed significant improvement with a decrease in average velocity (F=4.522, p=0.026), path length (F=4.592: p=0.024) and improvement of stability score (F=8.283, p=0.001). Dynamic balance measured by the time on the target variable also showed significant improvement at six-month follow-up (F=10.497: p=0.000). There was no significant difference between the affected and non-affected limb when compared at the different time intervals. The static and dynamic balance, which is impaired after ACL injury, improves with ACL reconstruction with PLT autologous graft. Hence PLTG can be safely used as a graft for ACL reconstruction without affecting postural control and body balance.

Our Experience on Peroneus Longus as Graft for Arthroscopic ACL Reconstruction

Our Experience on Peroneus Longus as Graft for Arthroscopic ACL Reconstruction

Primary anterior cruciate ligament reconstruction using full-thickness peroneus longus tendon autograft

Abstract Introduction Many grafts have been described for ACL reconstruction; however, disagreements regarding globally accepted gold standard graft choice persist. Recently, the peroneus longus tendon (PLT) Autograft has been used in the field of ACL reconstruction as an alternative autograft. This study aimed to evaluate the efficacy of the peroneus longus tendon as a graft for primary ACL reconstruction and to study its possible effects on foot and ankle function. Patients and methods This was a prospective study that included patients who underwent ACL reconstruction using Peroneus longus tendon autograft. Results were assessed via physical examination. Donor site morbidity of the foot and ankle was assessed using Medical American Orthopedic Foot &amp; Ankle Society (AOFAS) score and Foot and Ankle Disability Index (FADI). Postoperative knee function was evaluated by the International Knee Documentation Committee (IKDC) and Tegner-Lysholm score. Results Thirty patients were included in the study with a mean age of 28 years old. Peroneus longus graft diameter was 8.5 ± 0.7 mm. There was a significant difference between pre and postoperative functional scores in IKDC and Tegner-Lysholm score. Ankle scores were excellent. The mean of AOFAS was 97.7 ± 3.1 and FADI was 98.5 ± 0.5. Conclusion The peroneus longus tendon is an appropriate autograft source for ACL reconstruction. Its use in primary ACL reconstruction is very encouraging with minimal donor site morbidity.

Quadriceps tendon vs hamstring autograft in primary ACL reconstruction - a comparative study with minimum two-year follow-up.

Recently there has been growing interest in the quadriceps tendon (QUAD) as a valid option for reconstruction of the anterior cruciate ligament (ACLR). The aims of the study is to compare the outcomes achieved in anatomic ACLR involving QUAD vs. Hamstring (HT) autografts. A total of 52 consecutive patients underwent an ACLR, 25 patients with QUAD graft and 27 with HT graft. The same surgical technique, fixation method and postoperative protocol were used in both groups. The following parameters were evaluated: functional status (Lysholm, Tegner, subjective IKDC scores), joint stability (Lachman and pivot shift tests), surgical reoperation rate, complications, degree of satisfaction and return to previous level of activity. Descriptive statistics were analysed using the Student's t-test. Forty four patients were evaluated (20 QUAD, 24 HT), with a mean follow-up of 27.4 months. Two patients were re-operated in the QUAD group (including one ACL revision), and one patient in the HT group required an ACL revision. There were no significant differences between the two groups in postoperative scores: Lysholm (96.05 vs. 96.05), IKDC (86.2 vs. 91.2) and Tegner (6 vs. 5) scales. The percentage of negative Lachman and pivot shift tests was similar in the two groups (45% vs. 50% and 40% vs. 45.8%, respectively). There were no significant differences between the groups in the degree of satisfaction (95.8% vs. 80%, p = .16) or in the percentage who returned to their previous level of activity (62.5% vs. 45%, p = .17). The use of a QUAD graft in ACL reconstruction leads to similar clinical and functional outcomes to those obtained with HT.

No differences found in long-term outcomes of a randomized controlled trial comparing ipsilateral versus contralateral hamstring graft in ACL reconstruction.

Contralateral graft harvest in primary ACL reconstruction is relatively uncommon and the long-term comparative of this approach relative to ipsilateral harvest has not been described. The purpose of this study was to evaluate ACL graft and contralateral rupture following ipsilateral or contralateral semitendinosus and gracilis (STG) graft harvest at follow-up of a minimum 10years post-reconstruction in the treatment of a complete ACL tear. Patients from a previous randomized trial were evaluated. The primary outcome measures were ipsilateral and contralateral reinjury as well as the International Knee Documentation Committee (IKDC) knee assessment form, the ACL Quality of Life questionnaire (ACL-QoL) and the Tegner activity scale. Participants completed four different single-leg hop tests and concentric knee flexion and extension strength were assessed on an isokinetic dynamometer. Of the original 100 patients, 50 patients (41.3 ± 9.5years of age, 31 males, 19 females) reported on re-injury at 12.6 ± 1.4years post-operative. Thirty-eight patients returned for full assessment and 12 responded by mail or phone survey. There were no differences between groups for graft rupture, contralateral injury, ACL-QoL score, IKDC categorization, or anterior tibial translation, though both groups experienced a reduction in the Tegner Activity Scale from their preinjury scores. There was no difference in knee flexor and extensor isokinetic concentric strength, or single leg hop test performance. Knee flexor strength limb symmetry index was reduced when measured in the supine relative to the seated position in both groups, indicating persistent deficits in knee flexor strength when measured in the supine position. Contralateral hamstring harvest does not put patients at an increased risk of a contralateral ACL tear and long-term outcomes of ACL reconstruction do not differ based on the side of graft harvest. Contralateral STG harvest may provide a safe alternative surgical option for select patients. Level II.

Premature hamstring graft amputation during harvesting in ACL reconstruction.

IntroductionThere are some possible complications during or after hamstring graft harvesting such as premature graft amputation, medial collateral ligament injury and infrapatellar branch of the saphenous nerve injury. Premature graft amputation can occur by inadequate removal of the accessory branches of the hamstring tendons, poor surgical technique and/or too sharp tendon stripper. In this study, we report a case of premature hamstring graft amputation due to degeneration caused by osteochondroma at the posteromedial aspect of the proximal tibia.Case presentationWe reported the case of a 28-year-old Thai male who had an ACL injury was scheduled for ACL reconstruction. In this case, we had planned to use a hamstring graft for double-bundle ACL reconstruction. During the gracilis tendon harvesting, the graft was prematurely amputated by a tendon stripper at the level of the osteochondroma. The premature graft amputation was sent for pathology, which showed degenerated tissue.ConclusionIn cases of osteochondroma at the posteromedial aspect of the proximal tibia, it is a chance of premature hamstring graft amputation. We suggest removing the osteochondroma before harvesting the tendon grafts to avoid the risk of premature graft transection.

Post-Operative Radiological Outcome of Hamstring Graft in ACL Reconstruction after Augmentation of Graft with Periosteal Envelope

Post-Operative Radiological Outcome of Hamstring Graft in ACL Reconstruction after Augmentation of Graft with Periosteal Envelope

Ipsilateral peroneus longus tendon graft in failed ACL reconstruction: Our experience

Failure of ACL reconstruction is very common and may be due to technical failure or new traumatic injuries. The graft options in these cases are very limited and may include taking graft from opposite leg or allograft. The allograft availability is very limited in our country and is also very expensive. The use of graft from opposite leg gives morbidity to other side also. We describe our experience of using ipsilateral peroneus longus graft for failed ACL reconstruction cases. Methodology: six patients with failed ACL reconstruction with age less than 40 years old and having normal knee ROM were included in the study. Clinical tests and Lysholm score were used to evaluate the outcome. Graft site morbidity was assessed using AOFAS Score and ankle disability test. Results: Lachmann test and Pivot shift test was positive in all the six cases while these tests were negative at one year follow up with no signs of instability. The average Lysholm score pre-op was 66+/- while it was of 87 +/- 5 at the end of one year follow-up. There was no case of graft failure and reoperation after one year. Donor site Mean pre- and postoperative AOFAS scores were 100.0 ± 0.0 and 96.0 ± 9.6, respectively at 6-month follow-up (p = 0.06). Conclusion: Ipsilateral peroneus longus graft can be used for reconstruction in failed ACL cases with minimal morbidity at donor site and good clinical outcome

Quadriceps- vs. semitendinosus tendon in ACL reconstruction - a prospective study comparing autologous transplants regarding their clinical outcome

Aims and Objectives:The purpose of this study was to evaluate the knee stability and subjective outcome after primary ACL reconstruction using either autologous semitendinosus or quadriceps tendon.Materials and Methods:We evaluated a total of 50 patients who underwent ACL reconstruction - including 25 using the ipsilateral semitendinosus tendon (group I) and 25 patients with autologous quadriceps tendon graft (group II). The follow-up of this prospective comparative study was at least two years after surgery, comprising clinical assessment according to the International Documantation Committee (IKDC), KT1000 arthrometer testing and an additional questionnaire including the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Lysholm score.Results:The mean postoperative side-to-side difference assessed by KT1000 arthrometer was 1.8mm for group I and 1.7mm for group II with no statistically significant difference. There was no statistically significant difference neither in the individual KOOS subscores nor the Lysholm score. No re-rupture or positive pivot-shift test occurred during follow-up for both groups.Conclusion:Semitendinosus- as well as quadriceps tendon are both equal regarding their clinical outcome. Thus, the quadriceps tendon may serve as a good alternative graft for primary ACL reconstruction.

Factors that Predicts the Size of Autologous Hamstring Tendon Graft for Double-Bundle ACL Reconstruction.

To evaluate the effectiveness of demographic data and radiographic measurements for predicting the diameter and length of autologous semitendinosus (ST) and gracilis (GR) graft. Fifty-four cases were included to measure the size of 3 or 4 strands of ST and GR tendons retrospectively. The hamstring length on radiograph was defined as the length from the lowest point of ischial tuberosity to intercondylar notch of the femur. The linear and logistic regression analysis was used to assess the roles of the predictor variables, as demographic and radiologic data, in the outcome variables, as diameter of tendon grafts. The cross-validation with hold-out samples and concordance correlation coefficient (CCC) were also calculated. The hamstring and leg length measurement and gender were associated with the diameter of 4-stranded ST tendon graft. The hamstring length measurement, age and BMI were the factors associated with the diameter of 3-stranded ST tendon graft. The hamstring length measurement was found as a common factor for predicting diameters of hamstring tendon with reliable predictability. Moreover, the equation of multivariate regression analysis for the diameter of 4-stranded ST tendon graft showed the most validated power of prediction. All of the cross-validated R 2 values were calculated as similar results of multivariate model, but CCC between the measured diameter and estimated value on the predictive equation showed moderate agreement only (CCC = 0.694). Combining radiographic length measurements with demographic data showed reliable prediction in identifying the risk of inappropriate graft diameters. Level IV retrospective cohort study.

Functional outcomes of quadrupled semitendinosus vs. four strand semitendinosus / Gracilis graft for arthroscopic ACL reconstruction

Introduction: Anterior cruciate ligament is a commonly disrupted ligament causing anterior instability of knee. Arthroscopic ACL reconstruction is the treatment of choice. Many graft options are available most common being the four-strand hamstring autograft. Four strand hamstring graft can be made either by doubling both Semitendinosus and Gracilis tendon (STG) or by quadrupling Semitendinosus tendon (ST4). Aim: To compare functional outcomes following ACL reconstruction with STG graft vs ST4 graft using femoral adjustable loop button and tibial bio-screw fixation.Material and Methods: This was a prospective cohort study in which 68 patients with isolated ACL tear with knee instability were enrolled during 2017-2018. Patients with multi-ligamentous injury, associated meniscal tears, chondral lesions, juxta-articular fractures and previous surgery on same knee were excluded. Patients were randomly allocated into two groups in which Group one patient underwent Arthroscopic ACL reconstruction by autologous four strand STG graft and Group two patients using quadrupled ST4 graft. Functional evaluation was done using Lysholm scoring system preoperatively and postoperatively at 1 year. Knee flexion strength was measured post-operatively at 1 year as maximum standing knee flexion angle. The side to side ratio of knee flexion angle was used for comparison. Appropriate statistical analysis of the data was done. Results: 68 patients were enrolled for the study in which, 38 patients underwent Arthroscopic ACL reconstruction by Autologous four strand STG graft and 30 patients using quadrupled ST4 graft. Out of 68 patients 52(76.47%) were male and 16 (23.53%) were female. 50 (73.5%) patients had right sided involvement and 18 (26.4%) had left side involvement. Mean age of patients was 29 years ranging from 19-45 years. Mean follow-up duration was 20 months (14-32 months). Average duration since injury was 6.22 ± 4.68 months (2-24 months). Mean Pre-operative Lysholm score in STG and ST4 groups were 69.78 ± 8.46 and 68.6 ± 10.41 respectively. Mean post-operative Lysholm scores at 1 year in STG and ST groups were 91.5 ± 6.13 and 92.96 ± 6.00 respectively. Lysholm score was reported as excellent in 49 patients (72%), good in 12 patients (17.6%) and fair in 7 patients (10.2%) with none of the patients reporting poor outcome. Mean maximum standing knee flexion angle ratio of operated knee compared to non -operated knee at 1 year was 90.51±6.37% and 94.45 ±2.89% in STG and ST4 groups respectively. There were no major complications reported with the procedure. Conclusion: Quadrupled Semitendinosus graft is a viable alternative to Semitendinosus/Gracilis graft for ACL reconstruction. Preserving Gracilis tendon results in better knee flexion. Hence Gracilis tendon harvest must be avoided whenever possible.

ACL reconstruction: Which grafts can be used if hamstring is too small?

Hamstring grafts are the most often grafts used for ACL reconstruction procedures. Especially in Asia, hamstrings are preferable since small incision for taking the graft, and not produce anterior knee pain during kneeling, since there is no bony part taken. However, sometimes hamstring is too small for the graft. Many literatures mention that at least 7-8 mm needed for the best result of ACL reconstruction using hamstring tendon. It is not easy to predict the size of the hamstring tendon before surgery. Quadriceps tendons are good alternative as the grafts for ACL reconstruction. However, sometimes surgeons realize that hamstring is too small after they took the hamstring. The peroneus longus tendon can be added to the small hamstring. Even though peroneus longus tendon should not be used routinely, it could be considered if the hamstring that has been taken is too small.

ACL Reconstruction In High School and College-aged Athletes: Does Autograft Choice Affect Recurrent ACL Revision Rates?

Objectives: Physicians’ and patients’ decision-making process between bone-patellar tendon-bone (BTB) versus hamstring autografts for ACL reconstruction (ACLR) may be influenced by a patient’s gender, laxity level, sport played, and/or competition level in the young, active athlete. The purpose of this study was to determine the incidence of subsequent ligament disruption for high school and college-aged athletes between autograft BTB versus hamstring grafts for ACLRs. Our hypothesis is there would be no recurrent ligament failure differences between autograft types at 6-year follow-up. Methods: Our inclusion criteria were patients aged 14-22 who were injured in sport (basketball, football, soccer, other), had a contralateral normal knee, and were due to have a unilateral primary ACLR with either a BTB or hamstring autograft. All patients were prospectively followed at two and six years and contacted by phone and/or email to determine whether any subsequent surgery had occurred to either knee since their initial ACLR. If so, operative reports were obtained, whenever possible, in order to document pathology and treatment. Multivariable regression modeling controlled for age, gender, ethnicity/race, body mass index, sport and competition level, activity level, knee laxity, and graft type. The six-year outcomes of interest were the incidence of subsequent ACL reconstruction to either knee. Results: Eight hundred thirty-nine (839) patients were eligible, of which 770 (92%) had 6-year follow-up for subsequent surgery outcomes. The median age was 17, with 48% females, and the distribution of BTB to hamstring was 492 (64%) and 278 (36%) respectively. Thirty-three percent (33%) of the cohort was classified as having “high grade” knee laxity preoperatively. The overall ACL revision rate was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal ACL, and 19.7% had one or the other within 6 years of the index ACLR surgery. High-grade laxity (OR: 2.4; 95% CI: 1.4, 3.9; p=0.001), autograft type (OR: 2.1; 95% CI: 1.3, 3.5; p=0.004), and age (OR: 0.8; 95% CI: 0.7, 0.96; p=0.009) were the 3 most influential predictors of a recurrent ACL graft revision on the ipsilateral knee, respectively, whereas the sport of the index injury (OR: 0.3; 95% CI: 0.2, 0.7; p=0.002) was the most influential predictor of a subsequent primary ACL reconstruction on the contralateral knee. The odds of a recurrent ACL graft revision on the ipsilateral knee for patients receiving a hamstring autograft were 2.1 times the odds of a patient receiving a BTB autograft (95% CI: 1.3, 3.5). For low-risk patients (5% incidence of graft failure), a hamstring graft can increase the risk of recurrent ACL graft revision by 5 percentage points, from 5% to 10%. For high-risk patients (35% incidence of graft failure), a hamstring graft can increase the risk of recurrent ACL graft revision by 15 percentage points, from 35% to ˜ 50%. An individual prediction risk calculator for a subsequent ACL graft revision can be determined by the nomogram in Figure 1. Conclusion: There is a high rate of subsequent ACL tears in both the ipsilateral and contralateral knees in this young athletic cohort, with evidence suggesting that incidence of ACL graft revisions at 6 years following index surgery is significantly higher in hamstring autograft compared to BTB autograft. [Figure: see text]

Prospective study of functional outcome of Arthroscopic ACL reconstruction using semitendinosus tendon graft with a periosteal strip from anteromedial tibia

Background: Semitendinosus tendon is considered one of the best grafts for ACL reconstruction. Only if the semitendinosus graft is inadequate in length or diameter the need for gracilis tendon occurs. Harvesting the semitendinosus tendon along with a 1.5 to 2 cm periosteal strip from anteromedial tibia will increase the graft dimensions. The purpose of this study is to assess the functional outcome of ACL reconstruction with this modified form of semitendinosus graft. Materials and methods: Twenty patients with symptomatic ACL tear underwent arthroscopic ACL reconstruction using quadrupled semitendinosus tendon along with a strip of periosteum from the anteromedial tibia. No patient required gracilis tendon and all had a graft diameter of 8mm and above with a length greater than 7.5cm. Seventeen patients completed a period of one year follow up. Results: The average preoperative score was 61.24 (S.D.=5.8). After surgery, the average Tegner Lysholm score at one year was 87.76 (S.D.=4.1). This shows a significant improvement in the score (p value <0.01). Fourteen of the 17 patients had the entire range of knee motion restored. Two of them had 20 degrees loss of flexion and one had a fixed flexion deformity of 5 degrees. Two patients had superficial infection which subsided with antibiotics. One patient had graft impingement which was noticed intraoperatively and notchplasty was done. There was no graft failure for any of them. Conclusion: Harvesting semitendinosus tendon along with a strip of periosteum from the anteromedial tibia will improve the dimensions of the graft making it sufficient for ACL reconstruction. This will decrease the need for gracilis tendon and the morbidity associated with its harvest Keywords: ACL; Hamstring tendon; Semitendinosus; Gracilis

Biomechanical properties of adjustable extracortical graft fixations in ACL reconstruction

BackgroundReliable biomechanical data about the strength of different tibial extracortical graft fixation devices is sparse. This biomechanical study compares the properties of tibial graft fixation in ACL reconstruction with either the ACL Tight Rope™ or the Rigid Loop Adjustable™ device. The hypothesis was that both fixation devices would provide comparable results concerning gap formation during cyclic loading and ultimate failure load.MethodsSixteen sawbone tibiae (Sawbones™) underwent extracortical fixation of porcine flexor digitorum profundus grafts for ACL reconstruction. Either the ACL Tight Rope™ (Arthrex) or the Rigid Loop Adjustable™ (DePuy Mitek) fixation device were used, resulting in 2 groups with 8 specimens per group. Biomechanical analysis included pretensioning the constructs 10 times with 0.75 Hz, then cyclic loading of 1,000 position-controlled cycles and 1,000 force-controlled cycles applied with a servohydraulic testing machine. Elongation during cyclic loading was recorded. After this, ultimate failure load and failure mode analysis were performed.ResultsNo statistically significant difference could be noted between the groups regarding gap formation during cyclic loading (4.6 ± 2.6 mm for the Rigid Loop Adjustable™ vs. 6.6 ± 1.5 mm for the ACL Tight Rope™ (p > 0.05)), and ultimate failure loads (980 ± 101.9 N for the Rigid Loop Adjustable™ vs. 861 ± 115 N ACL Tight Rope™ (p > 0.05)).ConclusionACL Tight Rope™ and the Rigid Loop Adjustable™ fixation devices yield comparable biomechanical results for tibial extracortical graft fixation in ACL reconstruction. These findings may be of relevance for the future surgical decision-making in ACL reconstruction. Randomized controlled clinical trials comparing both fixation devices are desirable for the future.

Comparative study on fixed versus adjustable-length loop device for femoral fixation of graft in anterior cruciate ligament reconstruction

Aims and Objectives: Cortical suspension devices have been widely used in ACL reconstruction for femoral side graft fixation. Fixed-length and adjustable-length loop devices are two common suspensory loop devices that are used in ACL reconstruction. They both have their own biomechanical pros and cons. The purpose of this study is to determine the difference in functional outcome of anatomical single bundle ACL reconstruction using fixed length versus adjustable length loop in femoral fixation of quadrupled hamstring graft. Material and methods: It is a longitudinal prospective study conducted in Bone and Joint Centre, Kokilaben Dhirbhai Ambani Hospital (KDAH), Mumbai from Jan 2014 to June 2016. There were 60 patients enrolled in the study. The first 30 patients were treated with Arthroscopic ACL reconstruction in the first 30 patients were done with quadrupled hamstring graft from ipsilateral limb fixed with Endobutton on femoral side and bio-absorbable intrafix tibial screw, similarly in subsequent 30 patients ACL reconstruction were done with quadrupled hamstring graft from ipsilateral limb fixed with Tightrope on femoral side and bio-absorbable intrafix tibial screw. Their clinical and functional status were assessed pre-operatively on the day prior to surgery and the last follow up at one following the surgery with Tegner-Lysholm Score and 2000 IKDC scores. Results: The average Tegner- Lysolm score before surgery in Endobutton group was 56.63±6.7 and post op score at last follow up was 93.97±4.1 and for Tightrope group it was 56.5±7.1 and 94.7±3.7 respectively. The average 2000 IKDC score before surgery in Endobutton group was 46.16±6.1and post-op score at last follow up was 82.52±4.2 and for Tightrope group it was 46.57±6.5 and 83.98±4.1 respectively. Two sample student t-test was conducted to compare the mean of post-operative Tegner-Lysolm score and 2000 IKDC for each group it showed P value for Tegner-Lysolm score to be 0.75 and that for 2000 IKDC score to be 0.7, which not statistically significant to reject the null hypothesis. Discussion and conclusion: Cortical suspension devices for femoral tunnel graft fixation are very efficient devices whether Fixed-length or adjustable length. Fixed-length and adjustable loop cortical suspension devices are equally effective in femoral fixation of graft in ACL reconstruction.

Effect of silk fibroin/poly ( L-lactic acid-co-e-caprolactone) nanofibrous scaffold on tendon-bone healing of rabbits

To explore the effect of silk fibroin/poly( L-lactic acid-co-e-caprolactone) [SF/P(LLA-CL)] nanofibrous scaffold on tendon-bone healing of rabbits. SF/P(LLA-CL) nanofibrous scaffold was fabricated by electrospinning methods. The morphology of the scaffold was observed by scanning electron microscope (SEM). Pre-osteoblasts MC3T3-E1 cells were seeded on the scaffold and cultured for 1, 3, and 5 days. Cell adhesion and proliferation were also observed by SEM. Meanwhile, twenty-four New Zealand white rabbits were randomly divided into the autogenous tendon group (control group) and the autogenous tendon wrapped with SF/P(LLA-CL) scaffold group (experimental group), with twelve rabbits in each group. An extra-articular model was established, the effect was evaluated by histological examination and mechanical testing. The morphology of SF/P(LLA-CL) nanofibrous scaffold was random, with a diameter of (219.4±66.5) nm. SEM showed that the MC3T3-E1 cells seeded on the scaffold were in the normal shape, growing well, and proliferating with time course. The results of histological examination showed that inflammatory cells infltrated into the graft-host bone interface at 6 weeks after operation in both groups. Besides, the width of interface showed no significant difference between groups. At 12 weeks after operation, protruding new bone tissue could be observed at the interface in the experimental group, while scar tissue but no new bone tissue could be seen at the interface in the control group. Mechanical testing showed that there was no significant difference in the failure load and the stiffness between groups at 6 weeks after operation ( P>0.05). The failure load and the stiffness in the experimental group were significantly higher than those in the control group at 12 weeks after operation ( P<0.05). The SF/P(LLA-CL) nanofibrous scaffold has good cell biocompatibility and can effectively promote tendon-bone healing, thus providing new method for modifying graft for ACL reconstruction in the clinical practice.