A bigger suture diameter for anterior cruciate ligament all-inside graft link preparation leads to better graft stability: An anatomical specimen study

Abstract

Background: In anterior cruciate ligament reconstruction, different suture types are used for graft link preparation. Thus the aim of this study was to determine whether differences in the diameter of the suture used influence biomechanical stability of the prepared graft. We hypothesized that the use of a greater suture diameter leads to a higher load to failure rate in tested graft links.

Methods: In an anatomic specimen study, ligament preparation was enrolled in 15 cadaveric knees. The material used was the semitendinosus/gracilis tendon, which was fresh frozen (-80°) after harvesting for four weeks. The grafts were then defrosted, randomized into two groups and prepared with the same technique: 12 with a suture; FiberWire No. 2 and 12 with a FiberWire No. 0.

Results: Overall, the group using FiberWire No. 2 presented with a mean load to failure rate of 730.67N, mean overall final elongation of the graft was 5.98mm. In the FiberWire No. 0 group mean load to failure was with a mean overall elongation of the graft of 6.96mm. Significant differences (P=0.006) between the two groups with regard to the load to failure rate were found, with FiberWire No. 2 withstanding forces better. There was no difference in elongation of the grafts or mode to failure between the two groups.

Conclusions: Graft preparation with a bigger suture type is recommended to gain better load to failure rates, also in smaller-diameter grafts. Regarding the elongation rate, different suture types did not influence the outcome.

Level of evidence: Anatomical specimen study, Level III.

Keywords: Anatomical specimen study; Biomechanical testing; Load to failure; Suture diameter.