The Knee · 2025
The tensile strength of different methods of anterior cruciate ligament graft end stitches in an animal model.
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Dembski Marcin, Kawa Patryk, Tarnawski Jakub, Ceynowa Marcin, Żerdzicki Krzysztof, Kłosowski Paweł
Аннотация
BACKGROUND: There are several methods for stitching graft ends in anterior cruciate ligament reconstructive surgery. The tendon-suture construct should be able to withstand tensioning until the graft is stabilized with an implant.
METHODS: In this biomechanical study, 40 porcine lower extremity tendons ends were stitched with No. 2 suture, secured to the grips of the Zwick-Roell testing machine and tested for load at failure and type of failure (tendon v/s suture thread). The applied force was linear, the results are given in Newtons (N) as a mean. The Mann-Whitney U test was used for statistical analysis. The following constructs were compared: a whipstitch of each tendon end individually with 3, 4, and 5 passes through the tendon, a whipstitch of both tendon ends folded together and a tendon end knot without stitching.
RESULTS: All specimens survived the minimum tensile load of 80 N. The load at failure for whipstitch with 3,4 and 5 passes were 175 N, 211 N and 254 N respectively. The load at failure was greater for individual whipstitch than for both ends folded together (261 N v/s 152 N). The mean load at failure for braided graft was 209 N. The braided graft slips off the tendon before failure leading to uneven strength distribution during tensioning.
CONCLUSION: Increasing number of suture passes resulted in higher load at failure. Individual tendon ends whipstitched with 5 passes was the strongest construct. All of the investigated techniques are sufficient to withstand the suggested optimal graft tension of 80 N.
METHODS: In this biomechanical study, 40 porcine lower extremity tendons ends were stitched with No. 2 suture, secured to the grips of the Zwick-Roell testing machine and tested for load at failure and type of failure (tendon v/s suture thread). The applied force was linear, the results are given in Newtons (N) as a mean. The Mann-Whitney U test was used for statistical analysis. The following constructs were compared: a whipstitch of each tendon end individually with 3, 4, and 5 passes through the tendon, a whipstitch of both tendon ends folded together and a tendon end knot without stitching.
RESULTS: All specimens survived the minimum tensile load of 80 N. The load at failure for whipstitch with 3,4 and 5 passes were 175 N, 211 N and 254 N respectively. The load at failure was greater for individual whipstitch than for both ends folded together (261 N v/s 152 N). The mean load at failure for braided graft was 209 N. The braided graft slips off the tendon before failure leading to uneven strength distribution during tensioning.
CONCLUSION: Increasing number of suture passes resulted in higher load at failure. Individual tendon ends whipstitched with 5 passes was the strongest construct. All of the investigated techniques are sufficient to withstand the suggested optimal graft tension of 80 N.