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Suspensory Fixation Device for Use With Bone-Patellar Tendon-Bone Grafts.

ABSTRACT: Good to excellent results at long-term follow-up have been published for bone-patellar tendon-bone (BTB) graft anterior cruciate ligament reconstruction. Fixation using screws historically has been the most common choice for femoral and tibial bone blocks, but screws present several disadvantages, which include the risk of blowout (for which prevention implies having to shift the position of the tunnel anteriorly), as well as lesions of the bone blocks and tendons. This article describes a technique using Pullup BTB adjustable-loop length suspensory fixation (SBM, Lourdes, France) on the femoral and tibial sides. The graft is harvested and prepared classically. This device combines the advantages of suspensory fixation (precise position of the tunnel, high tensile strength), with the advantages of the adjustable loop (control of bone block position within the femoral tunnel, possibility of retightening the graft) and allows for double passage of the loop through each bone block for increased safety. So, it could represent an interesting and secure option for anatomic reconstruction of the anterior cruciate ligament when a BTB graft is chosen.

SUBMITTER: Colombet P

PROVIDER: S-EPMC5495964 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:PurposeThe purpose of this study was to evaluate three different methods of attachment of continuous loop suspensory cortical preparation of all soft tissue central quad tendon grafts compared to a bone block control for anterior cruciate ligament reconstruction on construct displacement and load to failure.MethodsThirty-two cadaveric central quadriceps tendon (CQT) specimens were harvested, using three clinical techniques for graft fixation: cortical button alone (BTB EB), BTB cortical button with rip-stop suture (BTB RS), and continuous loop cortical button (BTB CL). A control group was also included that consisted of a bone block secured within testing clamps (BTB CON). Specimens were preloaded to 150 N. Tendons were then cyclically loaded between 50 N and 250 N for 1,000 cycles at .5 Hz. Displacement was measured at the point of fixation of the CQT after the 150 N preload, 250 N initial load and every 100th cycle. The specimens were loaded to failure after 1,000 cycles.ResultsThere was a significant increase in displacement from .32 ± .56 mm for the BTB CON to 1.91 ± 1.13 mm for the BTB RS (P = .014) and 3.85 ± 2.32 mm for the BTB CL condition (P = .023). There was no significant increase in displacement for BTB EB (P = .182). Failure occurred for all of the BTB CL and 62.5% of the BTB EB specimens within the first 50 cycles. Twenty-five percent of the BTB CON specimens and 12.5% BTB RS failed at ∼400 and 500 cycles, respectively. Similar failure loads were observed for the BTB CON and the BTB RS (446.4 ± 151.46 N vs 505.74 ± 131.41 N; P = .99) Failure testing was not feasible for the BTB CL and BTB EB preparation methods.ConclusionIn response to cyclic loading, the three all-soft tissue suspensory conditions experienced significantly greater displacement compared to the bone block controls. None of the soft-tissue conditions appeared superior when compared to each other.Clinical relevanceIt remains unknown which method of soft-tissue suspensory provides optimal fixation. As these autografts become more common, it is essential to evaluate which fixation methods provide superior outcomes.

Dataset Information

Suspensory Fixation Device for Use With Bone-Patellar Tendon-Bone Grafts.

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