Bedi Asheesh, Smith Benjamin L, Mitchell Justin J, Frank Rachel M, Hauck Oliver L, Wijdicks Coen A
NorthShore Orthopedic and Spine Institute, Chicago, Illinois, USA.
Department of Orthopedic Research, Arthrex, Inc, Naples, Florida, USA.
Orthop J Sports Med. 2024 Oct 9;12(10):23259671241288578. doi: 10.1177/23259671241288578. eCollection 2024 Oct.
Favorable collagen fibril density and thickness combined with advances in graft preparation and fixation have significantly increased interest in the quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction. While various suspensory techniques have been described, the biomechanical profile of these constructs is largely undefined.
To compare the biomechanics of suspensory techniques for soft tissue QT autograft fixation in an in vitro model of ACL reconstruction.
Controlled laboratory study.
Full-thickness QT grafts were harvested using a 9-mm graft blade. Adjustable-loop devices (ALDs) were secured to the graft (n = 6 per group) with a combination implant containing the ALD and suture tape-reinforced whipstitching (tape-reinforced [TR] group), tethered superficially to the graft with a whipstitch (onlay [OL] group), luggage-tagged through and around the graft (luggage tag [LT] group), or staggered behind superficial suturing (staggered [SG] group). Grafts were tested on an electromechanical testing machine following a validated in vitro reconstruction model of intraoperative workflow and postoperative ACL kinematics, cyclic loading, and load to failure.
The TR group had significantly less postcyclic tension loss (mean, 24%) compared with the OL (56%; = .002), LT (69%; < .001), and SG (90%; < .001) constructs. Cyclic elongation was below the 3.0-mm threshold defined as clinical failure for TR (1.6 mm), but not for OL (3.3 mm), LT (7.9 mm), and SG (11.3 mm). All constructs were within native ACL stiffness limits (220 ± 72 N/mm) without significant differences. Ultimate loads significantly exceeded a normal ACL loading limit of 454 N for TR (739 N; = .023), OL (547 N; = .020), and LT (769 N; = .001), but not for SG (346 N; = .236).
The TR ALD construct demonstrated the most favorable time-zero biomechanical properties of modern soft tissue QT suspensory constructs, with 32% less tension loss and 52% less cyclic elongation versus the closest construct. Failure loading of all constructs was acceptable with respect to the native ACL except for the SG group, which had suboptimal ultimate load.
TR ALD implants may protect soft tissue QT autografts before graft-bone healing in ACL reconstruction by minimizing time-zero laxity and fixation failure.
良好的胶原纤维密度和厚度，以及移植物制备和固定技术的进步，显著提高了人们对使用股四头肌肌腱（QT）自体移植物进行前交叉韧带（ACL）重建的兴趣。虽然已经描述了各种悬吊技术，但这些结构的生物力学特性在很大程度上尚不明确。
在ACL重建的体外模型中比较软组织QT自体移植物固定的悬吊技术的生物力学性能。
对照实验室研究。
使用9毫米的移植物刀片采集全层QT移植物。将可调环装置（ALD）通过包含ALD和缝线带加强的锁边缝合法的组合植入物固定到移植物上（缝线带加强[TR]组），通过锁边缝合法浅面固定到移植物上（覆盖[OL]组），穿过并环绕移植物进行行李牌式固定（行李牌[LT]组），或在浅面缝合后交错固定（交错[SG]组）。按照术中工作流程和术后ACL运动学、循环加载及失效载荷的经过验证的体外重建模型，在机电测试机上对移植物进行测试。
与OL组（56%；P = 0.002）、LT组（69%；P < 0.001）和SG组（90%；P < 0.001）的结构相比，TR组的循环后张力损失显著更少（平均24%）。TR组的循环伸长低于定义为临床失败的3.0毫米阈值（1.6毫米），而OL组（3.3毫米）、LT组（7.9毫米）和SG组（11.3毫米）则不然。所有结构均在天然ACL刚度极限（220±72 N/mm）范围内，无显著差异。TR组（739 N；P = 0.023）、OL组（547 N；P = 0.020）和LT组（769 N；P = 0.001）的极限载荷显著超过正常ACL加载极限454 N，但SG组（346 N；P = 0.236）则未超过。
TR ALD结构在现代软组织QT悬吊结构中表现出最有利的初始生物力学性能，与最接近的结构相比，张力损失减少32%，循环伸长减少52%。除SG组极限载荷不理想外，所有结构的失效载荷相对于天然ACL来说都是可接受的。
TR ALD植入物可通过最小化初始松弛度和固定失败，在ACL重建中移植物与骨愈合之前保护软组织QT自体移植物。
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