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J Knee Surg. 2019 Jul 3. doi: 10.1055/s-0039-1692649. [Epub ahead of print]

Independent Suture Tape Internal Brace Reinforcement of Bone-Patellar Tendon-Bone Allografts: Biomechanical Assessment in a Full-ACL Reconstruction Laboratory Model.

Author information

1
Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
2
Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
3
Department of Research and Development, Arthrex Inc., Naples, Florida.

Abstract

Internal bracing for anterior cruciate ligament (ACL) surgery is a relatively new concept. The purpose of this study was to evaluate the effects of an "independent" button-fixed internal brace on the biomechanical properties of ACL reconstruction in a full-construct experimental model. Three groups (n = 10 each) were tested in a full-construct porcine-bone model with human bone-patellar tendon-bone allografts using different reconstruction techniques: interference screw fixation on femur and tibia (S-S group), adjustable-loop device (ALD) fixation on the femur with tibial interference screw without suture tape (ALD-S group), and with internal brace (ALD-S-IB group). Measured outcomes included cyclic displacement, stiffness, and ultimate load to failure. The ALD-S-IB group (2.9 ± 0.8 mm) displaced significantly less than the ALD-S (4.2 ± 0.9 mm; p = 0.015) and S-S group (4.3 ± 1.1 mm; p = 0.017). No significant difference was found between the ALD-S and the S-S group. Construct stiffness was significantly higher for the ALD-S-IB group (156 ± 23 N/mm) and the ALD-S group (122 ± 28 N/mm) than for the S-S group (104 ± 40 N/mm; p = 0.003 and p = 0.0042), but there was no significant difference between both ALD groups. Similarly, ultimate loads in the ALD-S-IB (758 ± 128 N) and the ALD-S groups (628 ± 223 N) were significantly greater than in the S-S group (416 ± 167 N; p < 0.001 and p = 0.025), but there was no significant difference between ALD groups. Adding an internal brace reinforcement to an ALD in a full-construct experimental model significantly decreased cyclic displacement by 31% without increasing construct stiffness or ultimate load significantly. These results indicate that suture tape internal bracing of bone-patellar tendon-bone allograft ACL reconstruction decreases cyclic displacement during experimental testing, which has clinical implications regarding initial construct stability.

PMID:
31269528
DOI:
10.1055/s-0039-1692649

Conflict of interest statement

P.A.S. reports personal fees, non-financial support and other from Arthrex, Inc., during the conduct of the study; personal fees from Arthrex, Inc., grants from Columbia Orthopaedic Group.C.A.W. and J.K. are employees of Arthrex, Inc.J.P.B. reports other from AOSSM, outside the submitted work; and J.P.B. received royalties for an unrelated product from Arthrex, Inc.

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