Suture Tape Augmentation Increases the Time-Zero Stiffness and Strength of Anterior Cruciate Ligament Grafts: A Cadaveric Study

Stephen J Torres; Trevor J Nelson; Nathalie Pham; William Uffmann; Orr Limpisvasti; Melodie F Metzger

doi:10.1016/j.asmr.2022.02.008

Suture Tape Augmentation Increases the Time-Zero Stiffness and Strength of Anterior Cruciate Ligament Grafts: A Cadaveric Study

Arthrosc Sports Med Rehabil. 2022 Jun 28;4(4):e1253-e1259. doi: 10.1016/j.asmr.2022.02.008. eCollection 2022 Aug.

Authors

Stephen J Torres¹, Trevor J Nelson², Nathalie Pham³, William Uffmann⁴, Orr Limpisvasti¹, Melodie F Metzger^{3

4}

Affiliations

¹ Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California.
² Cedars-Sinai Orthopaedic Biomechanics Laboratory, Los Angeles, California.
³ Cedars-Sinai, Department of Orthopaedic Surgery, Los Angeles, California.
⁴ Essentia Health, Duluth, Minnesota, U.S.A.

Abstract

Purpose: To determine the postsurgical strength and stiffness of anterior cruciate ligament (ACL) reconstructions with (ACLR-SA) and without suture tape augmentation (ACLR) in a human cadaveric model.

Methods: Eight matched pairs of cadaveric knees were tested intact and after bone-patellar tendon-bone ACL reconstruction. Specimens were potted and loaded onto a mechanical testing system, and an anterior drawer force of 88N was applied at 0°, 15°, 30°, 60°, and 90° of flexion. Specimens were then loaded to failure, with clinical failure defined as anterior translation greater than 10 mm.

Results: ACL-intact knees translated an average of 4.99 ± 0.28 mm across all flexion angles when an 88N anterior load was applied. ACLR knees had significantly greater translation compared to intact specimens. ACLRs with suture augmentation had less of an increase (0.67 mm, 95% confidence interval [CI]: 0.20, 1.14, P < .01) than those without suture augmentation (1.42 mm, 95% CI: 0.95, 1.89, P < .001). ACLR-SA required greater anterior load (170.4 ± 38.1 N) to reach clinical failure compared to ACLR alone (141.8 ± 51.2 N), P = .042. In addition, stiffness of ACLR-SA constructs (23.5 ± 3.3) were significantly greater than ACLR alone (20.3 ± 3.9), P = .003.

Conclusion: Augmentation of ACLR with suture tape allowed full range of motion with improved graft stiffness and increased failure load compared to unaugmented ACLR in this time-zero study.

Clinical relevance: Internal bracing may help reinforce ACLR grafts and allow for acceleration of rehabilitation protocols and earlier return to activity.