Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 10 (1), 538

Biomechanical Comparison of the Use of Different Surgical Suture Techniques for Continuous Loop Tendon Grafts Preparation

Affiliations

Biomechanical Comparison of the Use of Different Surgical Suture Techniques for Continuous Loop Tendon Grafts Preparation

Chen Zhang et al. Sci Rep.

Abstract

We introduce a new approach for a continuous loop tendon-graft preparation, benchmarking it against established graft preparation techniques widely used in conjunction with non-adjustable interference screw fixation. A four-strand bovine tendon graft was prepared using the following graft preparation techniques: standard graft using the baseball stitch technique (M-tech group); continuous loop graft using the GraftLinkTM technique (Arthrex-tech group); continuous loop graft using the Kessler anastomosis technique (Kessler-tech group); and continuous loop graft using a Double-Z anastomosis technique (Double Z-tech group). Each group of eight specimens underwent cyclic loading followed by a load-to-failure test. The M-technique yielded a smaller graft diameter (8.4 ± 0.5 mm) compared to the statistically equivalent diameters of the three continuous loop techniques (8.9 ± 0.6 mm of Arthrex-tech group, 9.1 ± 0.4 mm of Kessler-tech group and 9.2 ± 0.6 mm of Double Z-Tech group). The continuous loop grafts formed by the Double Z-Technique showed outstanding performance among the tested techniques in terms of ultimate failure load (982 ± 121 N) and cyclic elongation (3.7 ± 1.0 mm). There was no significant difference between the four groups in cyclic stiffness. Of the assessed techniques, the Arthrex technique resulted in the lowest ultimate elongation (2.0 ± 0.7 mm), followed by the Double Z-tech (4.5 ± 1.8 mm), the M-tech (5.2 ± 3.9 mm), and the Kessler-tech (5.3 ± 2.4 mm). The Arthrex-tech group (5.98 ± 0.38 min) displayed the shortest graft preparation time, followed by the M-Tech (7.94 ± 0.58 min), Kessler-tech (9.03 ± 0.39 min) and Double Z-Tech (13.29 ± 1.14 min). Double Z-Tech can improve the construct of continuous loop tendon graft with regard to mechanical performance.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Schematic of the two tested tendon graft configurations.
Figure 2
Figure 2
The three tested continuous loop configuration graft techniques. (A) Continuous loop graft using GraftLinkTM (Arthrex) suture technique; (B) continuous loop graft using Kessler anastomosis technique; (C) continuous loop graft using Double-Z anastomosis technique.
Figure 3
Figure 3
Continuous loop graft preparation technique using Double-Z anastomosis. (A) A needle with #2 non-resorbable surgical thread was inserted from one side of the tendon cross section and passed through the tendon four times achieving a Z shaped anastomosis; (B) the needle passed in the tendon reversely achieving the second Z shaped anastomosis. The green dotted line showed the first Z shaped anastomosis and the red dotted line showed the second Z shaped anastomosis; (C) elevation view of the suture; (D) cross-sectional view of the suture; (E) same method was performed to sew another free end; (F) a surgical knot was knotted between the both free ends achieving a continuous loop graft.
Figure 4
Figure 4
(A) M-configuration tendon graft; (B) Continuous loop tendon graft; (C) Biomechanical testing of a quadrupled continuous loop graft sample with a two double-looped loading ropes through the closed ends of the graft; (D) Typical test curves and parameterization. ④: ramp to failure phase; (E) enlarged view of blue area in Fig. 3D. ① Preload phase; ② preconditioning phase; and ③ cycling testing phase. Black arrows: Circular contraction sutures applied to increase tensile strength of the construct and reduce its diameter.
Figure 5
Figure 5
Box plots of mechanical test results. (#P < 0.05, compared with M-Tech group; *P < 0.05, compared between 3 continuous loop grafts). (A) Diameter comparison; (B) ultimate failure load comparison; (C) cyclic elongation comparison; (D) ultimate elongation comparison; (E) cyclic stiffness comparison.

References

    1. Dargel J, et al. Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction. Strategies in Trauma and Limb Reconstruction. 2007;2:1–12. doi: 10.1007/s11751-007-0016-6. - DOI - PMC - PubMed
    1. Smith HC, et al. Risk factors for anterior cruciate ligament injury: a review of the literature-part 2: hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Sports Health. 2012;4:155–161. doi: 10.1177/1941738111428282. - DOI - PMC - PubMed
    1. Fayard JM, et al. Factors affecting outcome of ACL reconstruction in over-50-year-olds. Orthopaedics & Traumatology: Surgery & Research. 2019;105:S247–S251. - PubMed
    1. Persson A, et al. Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004–2012. The American Journal of Sports Medicine. 2014;42:285–291. doi: 10.1177/0363546513511419. - DOI - PubMed
    1. Pinczewski LA, et al. A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. The American Journal of Sports Medicine. 2007;35:564–574. doi: 10.1177/0363546506296042. - DOI - PubMed
Feedback