PURPOSE: Posterior cruciate ligament (PCL) reconstruction procedures have not been thoroughly evaluated under cyclic loading conditions. We tested the hypothesis that PCL reconstruction with a quadrupled flexor-tendon graft and fixation using tapes and staples is biomechanically superior to that fixed with sutures, a button, and a post-screw, and is comparable to reconstruction with a bone--patellar tendon--bone (BPTB) graft. STUDY DESIGN: In vitro biomechanical study. METHODS: A total of 45 porcine knees were used. The quadrupled flexor-tendon graft was fixed using the suture/button/post-screw procedure in 15 knees, and with the tape/staples procedure in another 15 knees. The remaining 15 knees underwent reconstruction with a BPTB graft secured with screws as the standard control. In each group of 15 knees, 5 underwent tensile testing without cyclic loading, and 10 underwent the same tensile test after 5,000 cycles of load-controlled or displacement-controlled loading. RESULTS: Each type of cyclic loading produced larger biomechanical changes in the knees fixed with the suture/button/post-screw procedure than in the knees secured using the other 2 procedures. CONCLUSIONS: In PCL reconstruction, the tape/staples procedure is biomechanically superior to the suture/button/post-screw procedure, and is comparable to the BPTB/screws procedure with regard to the ultimate failure load. Neither of the procedures using the quadrupled flexor-tendon graft was comparable to the BPTB graft in linear stiffness and the initial displacement after load-controlled cyclic testing. CLINICAL RELEVANCE: The biomechanical behaviors of PCL-reconstructed knees are significantly different, depending on surgical techniques.
PURPOSE: Posterior cruciate ligament (PCL) reconstruction procedures have not been thoroughly evaluated under cyclic loading conditions. We tested the hypothesis that PCL reconstruction with a quadrupled flexor-tendon graft and fixation using tapes and staples is biomechanically superior to that fixed with sutures, a button, and a post-screw, and is comparable to reconstruction with a bone--patellar tendon--bone (BPTB) graft. STUDY DESIGN: In vitro biomechanical study. METHODS: A total of 45 porcine knees were used. The quadrupled flexor-tendon graft was fixed using the suture/button/post-screw procedure in 15 knees, and with the tape/staples procedure in another 15 knees. The remaining 15 knees underwent reconstruction with a BPTB graft secured with screws as the standard control. In each group of 15 knees, 5 underwent tensile testing without cyclic loading, and 10 underwent the same tensile test after 5,000 cycles of load-controlled or displacement-controlled loading. RESULTS: Each type of cyclic loading produced larger biomechanical changes in the knees fixed with the suture/button/post-screw procedure than in the knees secured using the other 2 procedures. CONCLUSIONS: In PCL reconstruction, the tape/staples procedure is biomechanically superior to the suture/button/post-screw procedure, and is comparable to the BPTB/screws procedure with regard to the ultimate failure load. Neither of the procedures using the quadrupled flexor-tendon graft was comparable to the BPTB graft in linear stiffness and the initial displacement after load-controlled cyclic testing. CLINICAL RELEVANCE: The biomechanical behaviors of PCL-reconstructed knees are significantly different, depending on surgical techniques.
Authors: Pisit Lertwanich; Cesar A Q Martins; Yuki Kato; Sheila J M Ingham; Scott Kramer; Monica Linde-Rosen; Patrick Smolinski; Freddie H Fu Journal: Knee Surg Sports Traumatol Arthrosc Date: 2010-04-21 Impact factor: 4.342