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Preparation techniques for all-inside ACL cortical button grafts: a biomechanical study

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Performing all-inside anterior cruciate ligament reconstruction using cortical button fixation, the tendon graft has to be secured in a closed loop with sutures. In the present study, the graft secured with four sutures was compared with two reduced-suture material graft preparation techniques.

Methods

A bovine tendon graft folded over two adjustable-length loop cortical button devices was secured using the following techniques: 1, four buried-knot sutures; 2, two sutures on the tibial end only; and 3, two sutures on the tibial graft end with additional suspension on the tibial cortical button. Each group consisted of eight specimens and underwent cyclic loading followed by a load-to-failure test.

Results

The least graft elongation after cyclic loading was observed for the graft with four sutures (6.1 ± 0.6 mm), followed by the graft with two sutures and additional suspension (6.3 ± 0.8 mm) and the graft with two sutures (7.0 ± 0.7 mm). The difference in graft elongation between four sutures and only two sutures was significant (P < 0.05). The ultimate failure loads were highest for the graft with two sutures and additional suspension (801 ± 107 N), followed by the graft with four sutures (766 ± 70 N), and the graft with two sutures (699 ± 87 N). No significant (n.s.) differences were observed between the ultimate failure loads in the three groups.

Conclusions

For the reduction in suture material to two sutures, additional suspension can be used in order to reduce the graft lengthening. Performing a suture-reducing graft can save operating time and costs. However, each of the three all-inside button graft techniques showed considerable graft elongation indicating a risk of graft lengthening in the early postoperative period.

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Acknowledgments

The authors thank Clemens Unterwurzacher for the illustrations and photography, and Arthrex Inc. for providing all implants free of charge.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The manuscript does not contain clinical studies or patient data.

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Authors and Affiliations

  1. Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Raul Mayr, Christian Heinz Heinrichs, Martin Eichinger, Werner Schmoelz & René Attal

  2. AUVA Trauma Center Klagenfurt, Waidmannsdorferstrasse 35, 9021, Klagenfurt, Austria

    Vinzenz Smekal

Authors
  1. Raul Mayr
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  2. Christian Heinz Heinrichs
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  3. Martin Eichinger
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  4. Vinzenz Smekal
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  5. Werner Schmoelz
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  6. René Attal
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Corresponding author

Correspondence to René Attal.

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Mayr, R., Heinrichs, C.H., Eichinger, M. et al. Preparation techniques for all-inside ACL cortical button grafts: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 24, 2983–2989 (2016). https://doi.org/10.1007/s00167-015-3605-9

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  • DOI: https://doi.org/10.1007/s00167-015-3605-9

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