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Preparation techniques for all-inside ACL cortical button grafts: a biomechanical study.

Raul Mayr1, Christian Heinz Heinrichs1, Martin Eichinger1

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Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
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PubMed
Summary

Reducing suture use in anterior cruciate ligament (ACL) reconstruction with cortical button fixation can save time and costs. However, all tested techniques showed significant graft elongation, posing a potential risk in early recovery.

Keywords:
ACL reconstructionAll-insideAnterior cruciate ligamentBiomechanicsCortical fixationHamstring graft

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Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Sports Medicine

Background:

  • All-inside anterior cruciate ligament (ACL) reconstruction utilizes cortical button fixation, requiring secure graft loops with sutures.
  • Optimizing graft preparation techniques is crucial for surgical efficiency and patient outcomes.

Purpose of the Study:

  • To compare the biomechanical properties of anterior cruciate ligament (ACL) grafts secured with four sutures versus reduced-suture techniques (two sutures) using cortical button fixation.
  • To evaluate graft elongation and ultimate failure load under cyclic and destructive testing.

Main Methods:

  • Bovine tendon grafts were prepared using three techniques: four sutures, two sutures on the tibial end, and two sutures with additional tibial cortical button suspension.
  • Eight specimens per group underwent cyclic loading followed by load-to-failure testing to assess biomechanical performance.

Main Results:

  • Graft elongation after cyclic loading was lowest with four sutures (6.1 mm), followed by two sutures with suspension (6.3 mm), and two sutures alone (7.0 mm).
  • The difference in elongation between four and two sutures was statistically significant (P < 0.05).
  • Ultimate failure loads were highest for two sutures with suspension (801 N), followed by four sutures (766 N), and two sutures (699 N), with no significant differences between groups.

Conclusions:

  • Reducing suture material to two sutures with additional suspension effectively minimizes graft lengthening compared to two sutures alone.
  • While suture reduction offers potential time and cost savings, all tested all-inside button graft techniques exhibited considerable elongation, indicating a risk of early postoperative graft lengthening.