The buried knot technique for all inside graft link preparation leads to superior biomechanical graft link stability

The aim of this study was to measure and compare the biomechanical properties of two different graft link preparation techniques for anterior cruciate ligament reconstruction. We hypothesised that there would be differences in elongation, load at failure and failure mode due to the different graft link preparation techniques. Thirty fresh-frozen anatomical specimen knees were used. Both tendons (semitendinosus and gracilis) were harvested and randomly assigned to two groups. Graft links prepared with a continuous loop technique were allocated to group 1, whereas those prepared with a buried-knot technique were allocated to group 2. The mechanical properties of both techniques were measured. A mean load to failure of 731 N and an overall graft elongation of 6 mm was found in the continuous loop group. In the buried-knot group, a higher load to failure (848 N) and a lower mean overall elongation (5 mm) was found. The buried-knot technique showed better results with significantly higher load to failure and significantly less elongation compared to the continuous loop technique. It is essential in clinical practice to choose the most accurate technique for graft link preparation to ensure graft stability, especially in the early phase of recovery.