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Speed whip ripstop technique during anterior cruciate ligament reconstruction using quadriceps tendon results in higher fixation strength

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare the biomechanical strength of different fixation configurations using a suspensory button in a soft-tissue quadriceps tendon graft for Anterior Cruciate Ligament (ACL) reconstruction.

Methods

Thirty fresh-frozen bovine Achilles tendons (10 mm wide, 50 mm long, and 4 mm thick) were used in this study. Tendons were assigned to three groups (n = 10 per group) with different suture configurations using adjustable loops with a suspensory button: group A, with the threads of an adjustable loop fixed by crossing at the tip of the loop and the entire loop; group B, continuous loops with hanging buttons were directly sutured to the tendon with eight simple sutures; group C, fixation was performed using the speed whip ripstop technique. Tensile tests with five cycles of preloading were performed at 50 N, held at 50 N for 1 min, and load-to-failure testing was conducted until rupture at 5 mm/min. The difference in the elongation and the maximum load-to-failure force were measured.

Results

The average elongation was significantly larger in group B (16.6 ± 2.2 mm) than in groups A (10.3 ± 2.4 mm) and C (10.0 ± 1.0 mm), (p < 0.001). The average load-to-failure force varied significantly between the three groups, 157.5 ± 33.4 N in group A, 253.4 ± 45.5 N in group B, and 337.7 ± 21.0 N in group C, (p < 0.001).

Conclusion

Fixation using the speed whip ripstop technique to fix the suspensory button and soft-tissue transplant tendon resulted in minimal elongation and higher fixation strength. Simple devices that use this method have already been developed. Since it can be fixed using a relatively simple method, speed whip ripstop technique was shown to be advantageous for femoral fixation in ACL reconstruction using soft-tissue quadriceps tendon. The findings of this study could help surgeons reduce graft re-tear rates in ACL reconstruction using quadriceps tendons.

Level of evidence

N/A, laboratory control study.

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Data availability

The datasets are available from the corresponding author on reasonable request.

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Acknowledgements

I am grateful to Editage for carefully proofreading the manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa-city, 920-8641, Japan

    Tomoyuki Kanayama, Junsuke Nakase, Mitsuhiro Kimura, Rikuto Yoshimizu, Yusuke Yanatori, Yoshihiro Ishida & Hiroyuki Tsuchiya

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  1. Tomoyuki Kanayama
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  2. Junsuke Nakase
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  3. Mitsuhiro Kimura
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  4. Rikuto Yoshimizu
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  7. Hiroyuki Tsuchiya
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Contributions

The study was designed by TK and JN. All tendon preparations and sutures were performed by TK. The biomechanical testing performed by MK. All data were analyzed by RY. Data interpretation and manuscript preparation were undertaken by all authors. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Junsuke Nakase.

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Conflict of interest

The authors did not receive and will not receive any benefits or funding from any commercial party related directly or indirectly to the subject of this article.

Ethical approval

No ethics approval for this study was required by the institutional review board of our institute. Institutional review board approval was not required as bovine Achilles tendons originally processed for food consumption were used in this study.

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No informed consent for this study was required.

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Kanayama, T., Nakase, J., Kimura, M. et al. Speed whip ripstop technique during anterior cruciate ligament reconstruction using quadriceps tendon results in higher fixation strength. Knee Surg Sports Traumatol Arthrosc 31, 4068–4075 (2023). https://doi.org/10.1007/s00167-023-07482-0

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