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Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison

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Abstract

Quadriceps tendon with a patellar bone block may be a viable alternative to Achilles tendon for anterior cruciate ligament reconstruction (ACL-R) if it is, at a minimum, a biomechanically equivalent graft. The objective of this study was to directly compare the biomechanical properties of quadriceps tendon and Achilles tendon allografts. Quadriceps and Achilles tendon pairs from nine research-consented donors were tested. All specimens were processed to reduce bioburden and terminally sterilized by gamma irradiation. Specimens were subjected to a three phase uniaxial tension test performed in a custom environmental chamber to maintain the specimens at a physiologic temperature (37 ± 2 °C) and misted with a 0.9 % NaCl solution. There were no statistical differences in seven of eight structural and mechanical between the two tendon types. Quadriceps tendons exhibited a significantly higher displacement at maximum load and significantly lower stiffness than Achilles tendons. The results of this study indicated a biomechanical equivalence of aseptically processed, terminally sterilized quadriceps tendon grafts with bone block to Achilles tendon grafts with bone block. The significantly higher displacement at maximum load, and lower stiffness observed for quadriceps tendons may be related to the failure mode. Achilles tendons had a higher bone avulsion rate than quadriceps tendons (86 % compared to 12 %, respectively). This was likely due to observed differences in bone block density between the two tendon types. This research supports the use of quadriceps tendon allografts in lieu of Achilles tendon allografts for ACL-R.

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References

  • Belisle A, Bicos J, Geaney L, Anderson M, Obopilwe E, Rincon L et al (2007) Strain pattern comparison of double- and singlebundle anterior cruciate ligament reconstruction techniques with the native anterior cruciate ligament. Arthroscopy 23(11):1210–1217

    Article  PubMed  Google Scholar 

  • Butler DL, Kay MD, Stouffer DC (1986) Comparison of material properties in fascicle-bone units from human patellar tendon and knee ligaments. J Biomech 19(6):425–432

    Article  CAS  PubMed  Google Scholar 

  • Dargel J, Schmidt-Wiethoff R, Schneider T, Bruggemann G, Koebke J (2006) Biomechanical testing of quadriceps tendon-patellar bone grafts: an alternative graft source for press-fit anterior cruciate ligament reconstruction? Arch Orthop Trauma Surg 126:265–270

    Article  PubMed  Google Scholar 

  • Freedman K, D’Amato M, Nedeff D, Kaz A, Bach B (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31(1):2–11

    PubMed  Google Scholar 

  • Geib T, Shelton W, Phelps R, Clark L (2009) Anterior cruciate ligament reconstruction using quadriceps tendon autograft: intermediate-term outcome. Arthroscopy 25(12):1408–1414

    Article  PubMed  Google Scholar 

  • Hamner D, Brown C, Steiner M, Hecker A, Hayes W (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: Biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81(A(4)):549–557

    CAS  PubMed  Google Scholar 

  • Han HS, Seong SC, Lee S, Lee MC (2008a) Anterior cruciate ligament reconstruction. Clin Orthop Relat Res 466:198–204

    Article  PubMed Central  PubMed  Google Scholar 

  • Han HS, Seong SC, Lee S, Lee MC (2008b) Anterior cruciate ligament reconstruction : quadriceps versus patellar autograft. Clin Orthop Relat Res 466(1):198–204

    Article  PubMed Central  PubMed  Google Scholar 

  • Harris L, Smith D, Lamoreaux L, Purnell M (1997) Central quadriceps tendon for anterior cruciate reconstruction. Am J Sports Med 25(1):23–28

    Article  CAS  PubMed  Google Scholar 

  • Hoburg AT, Keshlaf S, Schmidt T, Smith M, Gohs U, Perka C et al (2010) Effect of electron beam irradiation on biomechanical properties of patellar tendon allografts in anterior cruciate ligament reconstruction. Am J Sports Med 38(6):1134–1140

    Article  PubMed  Google Scholar 

  • Howe J, Johnson R, Kaplan M (1991) Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part I: long-term follow up. Am J Sports Med 7:801–811

    Google Scholar 

  • ISO 11137-2:2006 Sterilization of health care products-radiation-Part 2: establishing the sterilization dose

  • Kaplan M, Howe J, Flemming B, Johnson R, Jarinen M (1991) Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft. Part II: a specific sport review. Am J Sports Med 19(5):458–462

    Article  CAS  PubMed  Google Scholar 

  • Lewis G, Shaw K (1997) Tensile properties of human tendo Achillis: effect of donor age and strain rate. J Foot Ankle Surg 36(6):435–445

    Article  CAS  PubMed  Google Scholar 

  • Liu S, Kabo M, Osti L (1995) Biomechanics of two types of Bone-tendon-bone graft for ACL reconstruction. J Bone Joint Surg (Br) 77-B:232–235

    Google Scholar 

  • Marshall J, Warren R, Wickiewicz T, Reider B (1979) The anterior cruciate ligament: a technique of repair and reconstruction. Clin Orthop 19:458–462

    Google Scholar 

  • Nicklin S, Waller C, Walker P, Chung W, Walsh W (2000) In vitro structural properties of braided tendon grafts. Am J Sports Med 28(6):790–793

    CAS  PubMed  Google Scholar 

  • Paessler H, Mastrokalos D (2003) Anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons, bone patellar tendon, or quadriceps tendon-graft with press fit fixation without hardware, a new and innovative procedure. Orthop Clin N Am 34:49–64

    Article  Google Scholar 

  • Santori N, Adriani E, Pederzini L (2004) ACL reconstruction using quadriceps tendon. Orthopedics 27(1):31–35

    PubMed  Google Scholar 

  • Schatzmann L, Brunner P, Staubli HU (1998) Effect of cyclic preconditioning on the tensile properties of human quadriceps tendons and patellar ligaments. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S56–S61

    Article  PubMed  Google Scholar 

  • Scheffler S, Sudkamp N, Gockenjan A, Hoffmann R, Weiler A (2002) Biomechanical comparison of hamstring and patellar tendon graft anterior cruciate ligament reconstruction techniques: the impact of fixation level and fixation method under cyclic loading. Arthroscopy 18(3):304–315

    Article  PubMed  Google Scholar 

  • Schindler A (2012) Surgery for anterior cruciate ligament deficiency: a historical perspective. Knee Surg Sports Traumatol Arthrosc 20:5–47

    Article  PubMed  Google Scholar 

  • Shelton W, Fagan B (2001) Autografts commonly used in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 19(5):259–264

    Google Scholar 

  • Siebold R, Buelow JU, Bos L, Ellerman A (2003) Primary ACL reconstruction with fresh-frozen patellar versus Achilles tendon allografts. Arch Orthop Trauma Surg 123:180–185

    CAS  PubMed  Google Scholar 

  • Staubli H, Schatzmann L, Brunner P, Rincon L, Nolte L (1996) Quadriceps tendon and patellar ligament: cryosectional anatomy and structural properties in young adults. Knee Surg Sports Traumatol Arthrosc 4:100–110

    Article  CAS  PubMed  Google Scholar 

  • Staubli H, Schatzmann L, Brunner P, Rincon L, Nolte L (1999) Mechanical tensile properties of the quadriceps tendon and patellar ligament in young adults. Am J Sports Med 27(1):27–34

    CAS  PubMed  Google Scholar 

  • Tashman S, Kopf S, Fu F (2008) The kinematic basis of anterior cruciate ligament reconstruction. Oper Tech Sports Med 16(3):116–118

    Article  PubMed Central  PubMed  Google Scholar 

  • West R, Harner C (2005) Graft Selection in anterior cruciate ligament reconstruction. J Am Acad Orthop Surg 13:197–207

    PubMed  Google Scholar 

  • Wren T, Yerby S, Beaupre G, Carter D (2001) Mechanical properties of the human aachilles tendon. Clin Biomech 16:245–251

    Article  CAS  Google Scholar 

  • Wren T, Lindsey D, Beaupre G, Carter D (2003) Effects of creep and cyclic loading on the mechanical properties and failure of human achilles tendon. Ann Biomed Eng 31:710–717

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Community Tissue Services, 2900 College Dr., Kettering, OH, 45420, USA

    Isaac Mabe & Shawn Hunter

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  1. Isaac Mabe
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  2. Shawn Hunter
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Correspondence to Isaac Mabe.

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Mabe, I., Hunter, S. Quadriceps tendon allografts as an alternative to Achilles tendon allografts: a biomechanical comparison. Cell Tissue Bank 15, 523–529 (2014). https://doi.org/10.1007/s10561-014-9421-5

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  • DOI: https://doi.org/10.1007/s10561-014-9421-5

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