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A Biomechanical Comparison of Alternative Graft Preparations for All-Inside Anterior Cruciate Ligament Reconstruction

Abstract:

Purpose: To biomechanically compare alternative graft constructs for all-inside anterior cruciate ligament (ACL)reconstruction in the event that the semitendinosus harvested is too narrow or too short to make a graft larger than 8 mm. Methods: Bovine extensor tendons were used to make 6 different 9-mm-diameter grafts: traditional 4-strand, anastomosis 4-strand, 6-strand, 3-strand, button-fixation 4-strand, and loop-and-tack 4-strand grafts. The grafts were then subjected to cyclic biomechanical testing followed by failure loading. Force at 3 and 5 mm of displacement and ultimate force were recorded for all grafts. Results: Compared with the traditional 4-strand graft, the only graft that showed significant biomechanical differences during the cyclic phase of testing was the button-fixation 4-strand graft, which was characterized by lower force at 3 mm of displacement (74 ± 34 N vs 122 ± 13 N, P =.004)and 5 mm of displacement (122 ± 35 N vs 172 ± 3 N, P =.006). During failure loading, ultimate force was significantly lower for both the 6-strand graft (491 ± 186 N, P =.041)and button-fixation 4-strand graft (326 ± 27 N, P <.001)than for the traditional 4-strand graft (778 ± 176 N). All other grafts were equivalent for the parameters tested. Conclusions: The anastomosis 4-strand, 3-strand, and loop-and-tack 4-strand grafts do not biomechanically differ in cyclic loading and ultimate force from traditional 4-strand grafts. This study supports the use of anastomosis 4-strand, 3-strand, or loop-and-tack 4-strand grafts in the event that a traditional all-inside 4-strand graft cannot be prepared from a harvested semitendinosus tendon in ACL reconstruction. Clinical Relevance: This study tests and describes alternatives to the traditional 4-strand semitendinosus autograft for all-inside ACL reconstruction in the event that the harvested tendon is not adequate.