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Impact of tendon suturing on the interference fixation strength of quadrupled hamstring tendon grafts

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Interference screw fixation of soft tissue grafts has been a widely used fixation technique for cruciate ligament reconstruction. Suturing of the graft construct prior to graft fixation has been proposed to increase fixation strength; however, the effect on mechanical properties has not been well characterized. The goal of this study was to determine whether uniform suturing of the tendon graft affects (1) ultimate fixation strength of the hamstring tendon graft and (2) motion of the tendon in the bone tunnel during cyclic loading when comparing sutured grafts vs. unsutured grafts.

Method

Eight pairs of matched mature porcine tibias (age <2 years) and eight paired fresh-frozen human quadrupled hamstring tendon grafts were used. One quadrupled graft from each pair was placed into one of two groups. In the group A a single cerclage suture 3 cm from the doubled end of the graft was placed to join the four tendon strands. In group B a heavy suture was used to tightly unite the four strands of tendon graft to provide a better grip for the interference screw during fixation. The grafts were placed in tibial bone tunnels that matched the graft’s diameter and fixed with an interference screw. The looped end of the graft and the attached tibia were rigidly fixed in a material testing machine. The graft constructs were subjected to 100 cycles of 20–250 N load, followed by a load-to-failure test. In addition, a motion analysis system was used during cyclic testing to better determine the amount of elongation at the graft–tunnel interface. Statistical analysis of the failure load and stiffness and the overall elongation following cyclical loading was performed using the Wilcoxon rank sum test. Level of significance was set at p < 0.05.

Results

Elongation at the tendon–bone interface during sub-maximal cyclic loading was 2.4 ± 1.4 mm (unsutured) vs. 2.0 ± 0.7 mm (sutured) (p > 0.05). Failure load of the grafts without sutures (634 ± 86 N) was significantly lower than with the sutures (837 ± 183 N). Ultimate stiffness of group A (283 ± 34 N/mm) was lower than that of group B (331 ± 51 N/mm); however, this was not statistically significant (p = 0.051).

Conclusion

This study confirms that suturing of the graft construct before interference screw fixation may increase ultimate failure load. However, an improvement of structural properties in response to cyclic loading with sub-maximal loads could not be confirmed. Clinicians using interference screw fixation may suture the graft to improve fixation strength; however, suturing does not appear to allow a more aggressive rehabilitation after surgery.

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Authors and Affiliations

  1. Clinic for Sports Traumatology at Cologne Merheim Medical Center, University of Witten-Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany

    Jürgen Höher

  2. St. Vinzenz Hospital Cologne, Clinic for Trauma, Orthopaedics, Hand- and Reconstructive Surgery, University of Cologne, Cologne, Germany

    Christoph Offerhaus

  3. Center for Musculoskeletal Surgery, Charité, Campus Virchow-Clinic, Humboldt-University of Berlin, Berlin, Germany

    Eric Steenlage

  4. Sporthopaedicum Berlin, Berlin, Germany

    Andreas Weiler

  5. Chiurgisch-Orthopädischer Praxisverbund, Berlin, Germany

    Sven Scheffler

Authors
  1. Jürgen Höher
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  2. Christoph Offerhaus
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  3. Eric Steenlage
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  4. Andreas Weiler
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  5. Sven Scheffler
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Correspondence to Jürgen Höher.

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Höher, J., Offerhaus, C., Steenlage, E. et al. Impact of tendon suturing on the interference fixation strength of quadrupled hamstring tendon grafts. Arch Orthop Trauma Surg 133, 1309–1314 (2013). https://doi.org/10.1007/s00402-013-1749-y

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  • DOI: https://doi.org/10.1007/s00402-013-1749-y

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