Pre-implantation of high-intensity suture into tendon grafts to prevent postoperative graft relaxation and creep in anterior cruciate ligament reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHANG Han ¹ , TANG Xiangyu ¹ , QU Feng ¹ , SHEN Xuezhen ¹ , WANG Jiangtao ² ,  LIU Yujie ¹

1. Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;
2. The Second Department of Orthopaedics, Chinese PLA Bethune International Peace Hospital, Shijiazhuang Hebei, 050000, P.R.China;

Corresponding author：

LIU Yujie, Email: liuyujie301@163.com

Keywords：

Relaxation; creep; anterior cruciate ligament; tendon transplantation; surgical treatment

DOI：

10.7507/1002-1892.201609114

Video：

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Objective To explore the feasibility of pre-implantation of high-intensity suture into tendon grafts to prevent postoperative graft relaxation and creep in anterior cruciate ligament (ACL) reconstruction. Methods Thirty-six specimens of ACL reconstruction graft were made using adult swine’s Achilles tendon. All the specimens were randomly divided into experimental group (groups A and C) and control group (groups B and D), 9 specimens each group. One double-strand Ultrabraid No.2 high-intensity suture was pre-implanted into the grafts of groups A and C. Groups A and B underwent a 1 000-cycles load test while groups C and D underwent a 3 000-cycles load test. Then a pull-out test was performed until failure. The displacements at different cycles (100, 500, 1 000, 2 000, and 3 000) in all groups and yield loads of groups C and D were measured and analyzed. Results The displacement of group A was significantly smaller than that of group B at the cycles of 100, 500, and 1 000 (P<0.05); the displacement of group C was significantly smaller than that of group D at every cycle (P<0.05). Additionally, the yield load of group C was significantly higher than that of group D (t=4.816,P=0.001). Conclusion Pre-implantation of high-intensity suture into tendon grafts play an important role in the prevention of postoperative graft creep and relaxation in ACL reconstruction.

Citation： CHANGHan, TANGXiangyu, QUFeng, SHENXuezhen, WANGJiangtao, LIUYujie. Pre-implantation of high-intensity suture into tendon grafts to prevent postoperative graft relaxation and creep in anterior cruciate ligament reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 42-45. doi: 10.7507/1002-1892.201609114 Copy

1.	Van Ginckel A, Verdonk P, Witvrouw E. Cartilage adaptation after anterior cruciate ligament injury and reconstruction: implications for clinical management and research? A systematic review of longitudinal MRI studies. Osteoarthritis Cartilage, 2013, 21(8): 1009-1024.
2.	Pauzenberger L, Syré S, Schurz M. “Ligamentization” in hamstring tendon grafts after anterior cruciate ligament reconstruction: a systematic review of the literature and a glimpse into the future. Arthroscopy, 2013, 29(10): 1712-1721.
3.	Mariscalco MW, Magnussen RA, Mehta D, et al. Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med, 2014, 42(2): 492-499.
4.	Ralles S, Agel J, Obermeier M, et al. Incidence of Secondary Intra-articular Injuries With Time to Anterior Cruciate Ligament Reconstruction. Am J Sports Med, 2015, 43(6): 1373-1379.
5.	刘畅, 刘玉杰. 关节镜下前交叉韧带重建术中移植物固定方法的研究进展. 中华腔镜外科杂志 (电子版), 2013, 6(1): 54-58.
6.	Trump M, Palathinkal DM, Beaupre L, et al. In vitro biomechanical testing of anterior cruciate ligament reconstruction: traditional versus physiologically relevant load analysis. Knee, 2011, 18(3): 193-201.
7.	Barber FA, Herbert MA, Beavis RC. Cyclic load and failure behavior of arthroscopic knots and high strength sutures. Arthroscopy, 2009, 25(2): 192-199.
8.	Collin P, Laubster E, Denard PJ, et al. The Nice knot as an improvement on current knot options: A mechanical analysis. Orthop Traumatol Surg Res, 2016, 102(3): 293-296.
9.	Shah MR, Strauss EJ, Kaplan K, et al. Initial loop and knot security of arthroscopic knots using high-strength sutures. Arthroscopy, 2007, 23(8): 884-888.
10.	Petri M, Dratzidis A, Brand S, et al. Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons. Knee Surg Sports Traumatol Arthrosc, 2015, 23(4): 1039-1045.
11.	Herbert A, Jones GL, Ingham E, et al. A biomechanical characterisation of acellular porcine super flexor tendons for use in anterior cruciate ligament replacement: investigation into the effects of fat reduction and bioburden reduction bioprocesses. J Biomech, 2015, 48(1): 22-29.
12.	Bates NA, Myer GD, Shearn JT, et al. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis. Clin Biomech (Bristol, Avon), 2015, 30(1): 1-13.
13.	Scheffler SU, Unterhauser FN, Weiler A. Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2008, 16(9): 834-842.
14.	Muller B, Bowman KF Jr, Bedi A. ACL graft healing and biologics. Clin Sports Med, 2013, 32(1): 93-109.
15.	Zaffagnini S, De Pasquale V, Marchesini Reggiani L, et al. Electronmicroscopy of the remodelling process in hamstring tendon used as ACL graft. Knee Surg Sports Traumatol Arthrosc, 2010, 18(8): 1052-1058.
16.	Wells HC, Edmonds RL, Kirby N, et al. Collagen fibril diameter and leather strength. J Agric Food Chem, 2013, 61(47): 11524-11531.
17.	Kondo E, Yasuda K, Katsura T, et al. Biomechanical and histological evaluations of the doubled semitendinosus tendon autograft after anterior cruciate ligament reconstruction in sheep. Am J Sports Med, 2012, 40(6): 315-324.
18.	Schindler O. The story of anterior cruciate ligament reconstruction-part 1. J Perioper Pract, 2012, 22(5): 163-171.
19.	Schindler O. The story of anterior cruciate ligament reconstruction-part 2. J Perioper Pract, 2012, 22(6): 189-196.
20.	Robert H, Es-Sayeh J, Heymann D, et al. Hamstring insertion site healing after anterior cruciate ligament reconstruction in patients with symptomatic hardware or repeat rupture: a histologie study in 12 patients. Arthroscopy, 2003, 19(9): 948-954.
21.	朱洪江, 郑祥, 关健, 等. 关节镜下前交叉韧带重建术后不同康复方案临床疗效对比. 中国老年学杂志, 2016, 36(10): 2442-2444.
22.	袁锋, 赵金忠, 王予彬, 等. 骨隧道内植入不同长度自体肌腱重建前交叉韧带生物力学研究. 中国修复重建外科杂志, 2009, 23(3): 290-293.
23.	Jung HJ, Vangipuram G, Fisher MB, et al. The effects of multiple freeze-thaw cycles on the biomechanical properties of the human bone-patellar tendon-bone allograft. J Orthop Res, 2011, 29(8): 1193-1198.

1. Van Ginckel A, Verdonk P, Witvrouw E. Cartilage adaptation after anterior cruciate ligament injury and reconstruction: implications for clinical management and research? A systematic review of longitudinal MRI studies. Osteoarthritis Cartilage, 2013, 21(8): 1009-1024.
2. Pauzenberger L, Syré S, Schurz M. “Ligamentization” in hamstring tendon grafts after anterior cruciate ligament reconstruction: a systematic review of the literature and a glimpse into the future. Arthroscopy, 2013, 29(10): 1712-1721.
3. Mariscalco MW, Magnussen RA, Mehta D, et al. Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction: a systematic review. Am J Sports Med, 2014, 42(2): 492-499.
4. Ralles S, Agel J, Obermeier M, et al. Incidence of Secondary Intra-articular Injuries With Time to Anterior Cruciate Ligament Reconstruction. Am J Sports Med, 2015, 43(6): 1373-1379.
5. 刘畅, 刘玉杰. 关节镜下前交叉韧带重建术中移植物固定方法的研究进展. 中华腔镜外科杂志 (电子版), 2013, 6(1): 54-58.
6. Trump M, Palathinkal DM, Beaupre L, et al. In vitro biomechanical testing of anterior cruciate ligament reconstruction: traditional versus physiologically relevant load analysis. Knee, 2011, 18(3): 193-201.
7. Barber FA, Herbert MA, Beavis RC. Cyclic load and failure behavior of arthroscopic knots and high strength sutures. Arthroscopy, 2009, 25(2): 192-199.
8. Collin P, Laubster E, Denard PJ, et al. The Nice knot as an improvement on current knot options: A mechanical analysis. Orthop Traumatol Surg Res, 2016, 102(3): 293-296.
9. Shah MR, Strauss EJ, Kaplan K, et al. Initial loop and knot security of arthroscopic knots using high-strength sutures. Arthroscopy, 2007, 23(8): 884-888.
10. Petri M, Dratzidis A, Brand S, et al. Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons. Knee Surg Sports Traumatol Arthrosc, 2015, 23(4): 1039-1045.
11. Herbert A, Jones GL, Ingham E, et al. A biomechanical characterisation of acellular porcine super flexor tendons for use in anterior cruciate ligament replacement: investigation into the effects of fat reduction and bioburden reduction bioprocesses. J Biomech, 2015, 48(1): 22-29.
12. Bates NA, Myer GD, Shearn JT, et al. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis. Clin Biomech (Bristol, Avon), 2015, 30(1): 1-13.
13. Scheffler SU, Unterhauser FN, Weiler A. Graft remodeling and ligamentization after cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 2008, 16(9): 834-842.
14. Muller B, Bowman KF Jr, Bedi A. ACL graft healing and biologics. Clin Sports Med, 2013, 32(1): 93-109.
15. Zaffagnini S, De Pasquale V, Marchesini Reggiani L, et al. Electronmicroscopy of the remodelling process in hamstring tendon used as ACL graft. Knee Surg Sports Traumatol Arthrosc, 2010, 18(8): 1052-1058.
16. Wells HC, Edmonds RL, Kirby N, et al. Collagen fibril diameter and leather strength. J Agric Food Chem, 2013, 61(47): 11524-11531.
17. Kondo E, Yasuda K, Katsura T, et al. Biomechanical and histological evaluations of the doubled semitendinosus tendon autograft after anterior cruciate ligament reconstruction in sheep. Am J Sports Med, 2012, 40(6): 315-324.
18. Schindler O. The story of anterior cruciate ligament reconstruction-part 1. J Perioper Pract, 2012, 22(5): 163-171.
19. Schindler O. The story of anterior cruciate ligament reconstruction-part 2. J Perioper Pract, 2012, 22(6): 189-196.
20. Robert H, Es-Sayeh J, Heymann D, et al. Hamstring insertion site healing after anterior cruciate ligament reconstruction in patients with symptomatic hardware or repeat rupture: a histologie study in 12 patients. Arthroscopy, 2003, 19(9): 948-954.
21. 朱洪江, 郑祥, 关健, 等. 关节镜下前交叉韧带重建术后不同康复方案临床疗效对比. 中国老年学杂志, 2016, 36(10): 2442-2444.
22. 袁锋, 赵金忠, 王予彬, 等. 骨隧道内植入不同长度自体肌腱重建前交叉韧带生物力学研究. 中国修复重建外科杂志, 2009, 23(3): 290-293.
23. Jung HJ, Vangipuram G, Fisher MB, et al. The effects of multiple freeze-thaw cycles on the biomechanical properties of the human bone-patellar tendon-bone allograft. J Orthop Res, 2011, 29(8): 1193-1198.

Chinese Journal of Reparative and Reconstructive Surgery

Pre-implantation of high-intensity suture into tendon grafts to prevent postoperative graft relaxation and creep in anterior cruciate ligament reconstruction

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