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Published on: September 29, 2023
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ACL graft compression: a method to allow reduced tunnel sizes in ACL reconstruction
Breck R Lord1,2, Henry B Colaco3, Chinmay M Gupte4
1The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ, UK.
Summary
Graft compression in ACL reconstruction effectively reduces graft size without compromising biomechanical properties or stability. This technique allows for smaller tunnels, minimizing bone loss and improving graft placement during surgery.
Area of Science:
- Orthopedic Surgery
- Biomedical Engineering
- Sports Medicine
Background:
- Graft diameter asymmetry is a common issue in Anterior Cruciate Ligament (ACL) reconstruction, often necessitating larger bone tunnels.
- This mismatch can lead to graft-tunnel complications and compromise surgical outcomes.
- Compression downsizing offers a potential solution by creating a uniform graft size for easier passage into appropriately sized tunnels.
Purpose of the Study:
- To quantify the effects of graft compression on the biomechanical properties and stability of peroneus longus (PL) tendon grafts.
- To evaluate the hypothesis that compression downsizing reduces graft cross-sectional area (CSA) without negatively impacting biomechanics or fixation stability.
Main Methods:
- Sixty-eight PL tendons were used; some were prepared into four-strand grafts and compressed (0.5-1 mm diameter).
- Changes in graft CSA were measured using an alginate mould technique.
- Biomechanical properties (cyclic strain, stiffness, ultimate load, stress, Young's modulus) and graft displacement under cyclic loading in a bone tunnel model were compared between compressed and control grafts.
Main Results:
- Compression significantly reduced graft CSA by 31% (doubled) and 21% (quadrupled) under specific stress levels.
- Compressed grafts showed a 19% re-expansion over 12 hours in vitro, compared to 2% for controls.
- No significant differences were found in biomechanical properties or graft stability (mean cyclic displacement 0.3 mm) between compressed and control groups.
Conclusions:
- Graft compression of allograft PL tendons does not induce detrimental biomechanical effects in vitro.
- Compressed grafts exhibit controlled re-expansion, maintaining size during simulated joint conditions.
- The technique offers potential benefits for ACL reconstruction by enabling smaller tunnels, reducing bone removal, and facilitating anatomical graft placement.
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