Independent Suture Tape Reinforcement of Small and Standard Diameter Grafts for Anterior Cruciate Ligament Reconstruction: A Biomechanical Full Construct Model

Arthroscopy. 2018 Feb;34(2):490-499. doi: 10.1016/j.arthro.2017.10.037. Epub 2017 Dec 21.


Purpose: To compare the dynamic elongation, stiffness behavior, and ultimate failure load of standard with small diameter soft tissue grafts for anterior cruciate ligament (ACL) reconstruction with and without high-strength suture tape reinforcement.

Methods: Both a tripled "small" diameter and a "standard" quadrupled tendon graft with and without suture tape reinforcement were tested using suspensory fixation (n = 8 each group). The suture tape was passed through the suspensory fixation button on the femur and tibia to ensure independent (safety belt) fixation from the graft in vitro. The testing of the constructs included position-controlled cyclic loading, force-controlled cyclic loading at 250 N and 400 N as well as pull to failure (50 mm/min).

Results: Reinforcement of a small diameter graft significantly reduced dynamic elongation of 38% (1.46 ± 0.28 mm vs 2.34 ± 0.44 mm, P < .001) and 50% (2.55 ± 0.44 mm vs 5.06 ± 0.67 mm, P < .001) after the 250 N and 400 N load protocol, respectively. Reinforcement of a standard diameter tendon graft decreased dynamic elongation of 15% (1.59 ± 0.34 mm vs 1.86 ± 0.17 mm, P = .066) and 26% (2.62 ± 0.44 mm vs 3.55 ± 0.44 mm, P < .001). No significant difference was found between both reinforced models. The ultimate failure loads of small and standard diameter reinforced grafts were 1592 ± 105 N and 1585 ± 265 N, resulting in a 64% (P < .001) and 40% (P < .001) increase compared with their respective controls.

Conclusions: Independent suture tape reinforcement of soft tissue grafts for ACL reconstruction leads to significantly reduced elongation and higher ultimate failure load according to in vivo native ACL function data without stress-shielding the soft tissue graft.

Clinical relevance: If in vitro results are translational to human knees in vivo, the suture tape reinforcement technique for ACL reconstruction may decrease the risk of graft tears, particularly in the case of small diameter soft tissue grafts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Biomechanical Phenomena
  • Cattle
  • Femur / surgery
  • Suture Techniques
  • Sutures*
  • Tendons / transplantation*
  • Tibia / surgery