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Postless Tape Augmentation for Posterior Cruciate Ligament Reconstruction

ABSTRACT: Many techniques have been described for posterior cruciate ligament (PCL) reconstruction, but residual laxity remains an ongoing challenge. Suture or tape augmentation during ligament reconstruction has become a popular option to prevent graft elongation but comes at the expense of additional costs due to implants for augment fixation, and concern for stress shielding of the graft if the augment and graft are not equally tensioned. We introduce a technique for postless tape augmentation during allograft PCL reconstruction that allows for equal tensioning of graft and augment through the use of a sheath and screw construct without the need for additional implants for augment fixation. Technique Video Video 1 This technique demonstrates a case using postless tape augmentation during posterior cruciate ligament (PCL) reconstruction. The tibial and femoral tunnels are first created with the assistance of an accessory posteromedial portal and drilling under direct arthroscopic and fluoroscopic visualization. An Achilles tendon allograft with a bone plug is used as the allograft. The bone plug and soft tissue are shaped to fit within 10-mm tunnels. A 2.5-mm suture tape (Dynatape, Depuy-Mitek, Johnson and Johnson, Raynham, MA) is then passed through a 2.5-mm drill hole in the bone block, which will be used as the postless augment for the graft. High-tensile strength suture (#2 Orthocord, Depuy-Mitek, Johnson and Johnson) is then passed through the end of the bone block and two additional high-tensile strength sutures (#2 Orthocord, Depuy-Mitek, Johnson and Johnson) are sutured into the soft tissue portion of the graft, in a Krackow suture pattern, to assist with graft passage. The graft is then passed through the tunnels in a retrograde fashion with the assistance of a shuttling suture. Once the graft has been passed out the femur, and the bone plug is fully seated in the most proximal extent of the tibial tunnel, it is secured in place using a metal interference screw, which is confirmed fluoroscopically. Final fixation of the graft is then performed with the knee placed at 90° of flexion, application of an anterior drawer, and insertion of a screw and sheath into the tunnel. It is essential to maintain tension on the allograft and tape during all steps of tibial screw and sheath placement. No additional fixation is required in the femur, as both the allograft and tape are well secured with the sheath and screw.

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PROVIDER: S-EPMC10150181 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Project description:BackgroundAnterior cruciate ligament (ACL) reconstruction aims to restore anteroposterior and rotatory stability to the knee following ACL injury. This requires the graft to withstand the forces applied during the process of ligamentisation and the rehabilitative period. We hypothesise that the use of suture tape augmentation of single bundle ACL reconstruction (ACLR) will reduce residual knee laxity and improve patient-reported outcomes at 2-year follow-up. We will conduct a 1:1 parallel arm single-centre randomised controlled trial comparing suture tape augmented ACLR to standard ACLR technique.MethodsThe study design will be a parallel arm 1:1 allocation ratio randomised controlled trial. Sixty-six patients aged 18 and over waitlisted for primary ACLR will be randomised. Patients requiring osteotomy and extra-articular tenodesis and who have had previous contralateral ACL rupture or repair of meniscal or cartilage pathology that modifies the post-operative rehabilitation will be excluded. The primary outcome measure will be the side-to-side difference in anterior tibial translation (measured on the GNRB arthrometer) at 24 months post-surgery. GNRB arthrometer measures will also be taken preoperatively, at 3 months and 12 months post-surgery. Secondary outcomes will include patient-reported outcome measures (PROMs) collected online, including quality of life, activity and readiness to return to sport, complication rates (return to theatre, graft failure and rates of sterile effusion), examination findings and return to sport outcomes. Participants will be seen preoperatively, at 6 weeks, 3 months, 12 months and 24 months post-surgery. Participants and those taking arthrometer measures will be blinded to allocation.DiscussionThis will be the first randomised trial to investigate the effect of suture-tape augmentation of ACLR on either objective or subjective outcome measures. The use of suture-tape augmentation in ACLR has been associated with promising biomechanical and animal-level studies, exhibiting equivalent complication profiles to the standard technique, with initial non-comparative clinical studies establishing possible areas of advantage for the technique. The successful completion of this trial will allow for an improved understanding of the in situ validity of tape augmentation whilst potentially providing a further platform for surgical stabilisation of the ACL graft.Trial registrationAustralia New Zealand Clinical Trial Registry ACTRN12621001162808. Universal Trial Number (UTN): U1111-1268-1487. Registered prospectively on 27 August 2021.

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Postless Tape Augmentation for Posterior Cruciate Ligament Reconstruction

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