'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY

J. Smith; T. Stephens; K. Paulson; P. Schneider; C. R. Martin

doi:10.1302/1358-992X.2022.7.005

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'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY

The British Association for Surgery of the Knee (BASK) May 2022 Meeting, Newport, Wales, 17–18 May 2022.

J. Smith
T. Stephens
K. Paulson
P. Schneider
C. R. Martin

'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY

Smith J, Stephens T, Paulson K, Schneider P, Martin CR. 'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY. Orthop Procs. 2022;104-B(SUPP_7):5-5. doi:10.1302/1358-992X.2022.7.005

Smith, J., et al. “'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY.” Orthopaedic Proceedings, vol. 104-B, no. SUPP_7, 2022, pp. 5-5., https://doi.org/10.1302/1358-992X.2022.7.005

Smith, J., Stephens, T., Paulson, K., Schneider, P., & Martin, C. R. (2022). 'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY. Orthopaedic Proceedings, 104-B(SUPP_7), 5-5. https://doi.org/10.1302/1358-992X.2022.7.005

Smith, J., Stephens, T., Paulson, K., Schneider, P. and Martin, C. R. (2022) “'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY.” Orthopaedic Proceedings, 104-B(SUPP_7), pp. 5-5. Available at: https://doi.org/10.1302/1358-992X.2022.7.005

Smith, J., T. Stephens, K. Paulson, P. Schneider, and C. R. Martin. “'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY.” Orthopaedic Proceedings 104-B, no. SUPP_7 (2022): 5-5. https://doi.org/10.1302/1358-992X.2022.7.005

Smith J, Stephens T, Paulson K, Schneider P, Martin CR. 'STRAIN SUTURE’ AUGMENTATION REDUCES ELONGATION AND INCREASES STIFFNESS OF ALL-TISSUE QUADRICEPS TENDON AUTOGRAFTS USED FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: A BIOMECHANICAL STUDY. Orthop Procs. 2022 Jul 1;104-B(SUPP_7):5-5. https://doi.org/10.1302/1358-992X.2022.7.005

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Abstract

Introduction

All-tissue quadriceps tendon (QT) is becoming an increasingly popular alternative to hamstrings tendon (HT) and bone-tendon-bone (BTB) autograft for anterior cruciate ligament (ACL) reconstruction. The relatively short graft length however dictates that one, or both, ends rely on suture fixation. The strength of this construct is therefore extremely important. This study evaluates whether the use of a novel fixation technique can improve the tensile properties of the construct compared to a Krackow suture, and a looped tendon (suture free) gold standard.

Methods

Eighteen porcine flexor tendons were tested, across three groups; suture-tape Krackow, looped tendon, and the novel ‘strain suture’. Biomechanical testing simulated the different stages of ACL graft preparation and loading (60N preload for 10 minutes, 10 cycles from 10N to 75N, and 1000 cycles from 100N to 400N). Elongation and load to failure were recorded, and stiffness calculated for each construct.

Results

The mean elongation was significantly improved for the strain suture compared to the suture tape Krackow for preload, 10 cycle and 1000 cycle testing protocols respectively (1.36mm vs 4.93mm, p<001; 0.60mm vs 2.72mm, p<0.001; 2.95mm vs 29.08mm, p<0.001). Compared with the looped tendon, the strain suture demonstrated similar results for preload and 10 cycle elongation, but greater elongation during the 1000 cycle stage. Stiffness of the latter two constructs was similar.

Conclusions

Augmentation of the suture fixation using this novel technique provides a construct that is significantly superior to currently practised suture techniques, and similar in elongation and stiffness to a looped graft.