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Intraoperative Workflow for All-Inside Anterior Cruciate Ligament Reconstruction: An In Vitro Biomechanical Evaluation of Preconditioning and Knot Tying.

Intraoperative Workflow for All-Inside Anterior Cruciate Ligament Reconstruction: An In Vitro Biomechanical Evaluation of Preconditioning and Knot Tying.

Authors :
Monaco E
Bachmaier S
Fabbri M
Lanzetti RM
Wijdicks CA
Ferretti A
Source :
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2018 Feb; Vol. 34 (2), pp. 538-545. Date of Electronic Publication: 2017 Nov 13.
Publication Year :
2018

Abstract

Purpose: To evaluate and compare the effect of preconditioning according to intraoperative workflow on the elongation behavior of single-side and fully knotted all-inside anterior cruciate ligament (ACL) reconstruction configurations in a biomechanical in vitro study.<br />Methods: Four full construct all-inside ACL reconstruction groups (n = 8 per group) were tested using porcine tibias and bovine tendons. Groups included both an all-inside configuration with one- (group 1) and both-side knotted adjustable loop-length devices (group 2), without and with performing intraoperative preconditioning (group 1-intraoperative preconditioned [IPC], group 2-IPC). Adjustable loop-length devices for control groups were knotted according to test configurations. Intraoperative preconditioning specimens were further precycled for 10 times at 0.5 Hz and manually retensioned before knotting. All groups underwent dynamic cycling in position and force control mode each for 1,000 cycles at 0.75 Hz according to in vitro loading parameters replicating the in vivo ACL environment. Finally, a load-to-failure test at 50 mm/min was performed.<br />Results: Intraoperative preconditioning increases initial graft tension for single- (242 ± 22 N vs 174 ± 13 N; P < .0001) and both-side knotted configurations (225 ± 15 N vs 159 ± 10 N; P < .0001) compared with controls and allows maintained graft tension at higher levels until reaching the end of position-controlled cyclic loading. Furthermore, dynamic elongation is reduced for one- (1.93 ± 0.28 vs 0.76 ± 0.12; P < .0001) and both-side knotted (1.84 ± 0.20 vs 0.96 ± 0.32; P < .0001) configurations by 61% and 47%, respectively. No intergroup (group 1 vs group 2 and group 1-IPC vs group 2-IPC) statistically significant differences could be found between one- and both-side knotted configurations.<br />Conclusions: All-inside ACL reconstruction with preconditioning according to intraoperative workflow leads to a statistically significant improved mechanical behavior and may allow for optimizing initial graft tension and elongation for all-inside ACL reconstruction to reduce knee laxity. A single-side knotted configuration achieves similar stabilization strength to fully knotted constructs.<br />Clinical Relevance: Graft insertion until tunnel docking increases the intratunnel graft portion that may optimize graft incorporation. Eliminating a suture knot stack may improve intraoperative workflow and reduce postoperative knot irritation.<br /> (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1526-3231
Volume :
34
Issue :
2
Database :
MEDLINE
Journal :
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Publication Type :
Academic Journal
Accession number :
29146161
Full Text :
https://doi.org/10.1016/j.arthro.2017.08.283