Biomechanical Comparisons of Anterior Cruciate Ligament Avulsion Fracture Fixation Using High-Strength Suture and Ultra-High Molecular Weight Polyethylene Suture Tape in a Porcine Model

Abstract

A wide variety of fixation methods have been reported to fix anterior cruciate ligament (ACL) tibial avulsion fractures, but there have been no studies into the fixation of these fractures with ultra-high molecular weight polyethylene (UHMWPE) suture tape as an alternative to conventional thread. Type III ACL tibial avulsion fractures were created in 20 skeletally immature porcine knees. All specimens were randomized into two treatment groups: (1) pullout repair using no. 2 suture fixation and (2) pullout repair using UHMWPE suture tape fixation. The specimens were tested cyclically (20 cycles, 0–40 N, 100 mm/min) in the direction of the native ACL and loaded to failure (100 mm/min) on a tensile tester. Statistically significant differences between the structural properties (displacement, upper yield load, maximum load, linear stiffness, and elongation at failure) under cyclic loading and single-cycle loading were analyzed. Displacement during cyclic testing was 1.56 ± 1.03 mm in the UltraBraid group and 0.99 ± 0.48 mm in the SUTURETAPE group, with no significant differences found between the groups (p = 0.13). There were no significant differences in upper yield load (161.9 ± 68.9 N in the UltraBraid group, 210.4 ± 60.1 N in the SUTURETAPE group, p = 0.11), linear stiffness (14.7 ± 4.7N/mm in the UltraBraid group, 18.1 ± 7.9 N/mm in the SUTURETAPE group, p = 0.27), or elongation at failure (20.1 ± 8.0 mm in the UltraBraid group, 21.5 ± 7.2 mm in the SUTURETAPE group, p = 0.69). On the other hand, significant differences were observed in maximum load in the SUTURETAPE group (219.7 ± 89.2 N in the UltraBraid group, 319.3 ± 92.6 N in the SUTURETAPE group, p = 0.025).

Keywords

anterior cruciate ligament avulsion fracture fixation - high-strength suture - ultra-high molecular weight polyethylene suture tape - porcine model

Publication History

Received: 18 July 2020

Accepted: 12 November 2020

Article published online:
22 January 2021

• References

• 1 Lowe J, Chaimsky G, Freedman A, Zion I, Howard C. The anatomy of tibial eminence fractures: arthroscopic observations following failed closed reduction. J Bone Joint Surg Am 2002; 84 (11) 1933-1938
• 2 Seon JK, Park SJ, Lee KB. et al. A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures. Am J Sports Med 2009; 37 (12) 2334-2339
• 3 Osti L, Buda M, Soldati F, Del Buono A, Osti R, Maffulli N. Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods. Br Med Bull 2016; 118 (01) 73-90
• 4 Robinson JR, Frank EG, Hunter AJ, Jermin PJ, Gill HS. The strength of transosseous medial meniscal root repair using a simple suture technique is dependent on suture material and position. Am J Sports Med 2018; 46 (04) 924-932
• 5 Nakama GY, Aman ZS, Storaci HW, Kuczmarski AS, Krob JJ, Strauss MJ. Different suture materials for arthroscopic transtibial pull-out repair of medial meniscal posterior root tears: a human biomechanical study. Orthop J Sports Med 2019; 7 (09) 2325967119873274
• 6 Ezechieli M, Schäfer M, Becher C. et al. Biomechanical comparison of different fixation techniques for reconstruction of tibial avulsion fractures of the anterior cruciate ligament. Int Orthop 2013; 37 (05) 919-923
• 7 Meyers MH, Mckeever FM. Fracture of the intercondylar eminence of the tibia. J Bone Joint Surg Am 1959; 41A [phone] , discussion 220–222
• 8 Eggers AK, Becker C, Weimann A. et al. Biomechanical evaluation of different fixation methods for tibial eminence fractures. Am J Sports Med 2007; 35 (03) 404-410
• 9 Takahashi T, Kondo E, Yasuda K. et al. Effects of remnant tissue preservation on the tendon graft in anterior cruciate ligament reconstruction: a biomechanical and histological study. Am J Sports Med 2016; 44 (07) 1708-1716
• 10 Cone SG, Warren PB, Fisher MB. Rise of the pigs: utilization of the porcine model to study musculoskeletal biomechanics and tissue engineering during skeletal growth. Tissue Eng Part C Methods 2017; 23 (11) 763-780
• 11 Yoshikawa T, Tohyama H, Katsura T. et al. Effects of local administration of vascular endothelial growth factor on mechanical characteristics of the semitendinosus tendon graft after anterior cruciate ligament reconstruction in sheep. Am J Sports Med 2006; 34 (12) 1918-1925
• 12 Kondo E, Yasuda K, Katsura T, Hayashi R, Azuma C, Tohyama H. Local administration of autologous synovium-derived cells improve the structural properties of anterior cruciate ligament autograft reconstruction in sheep. Am J Sports Med 2011; 39 (05) 999-1007
• 13 Kondo E, Yasuda K, Katsura T, Hayashi R, Kotani Y, Tohyama H. Biomechanical and histological evaluations of the doubled semitendinosus tendon autograft after anterior cruciate ligament reconstruction in sheep. Am J Sports Med 2012; 40 (02) 315-324
• 14 Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48 (03) 452-458
• 15 Tudisco C, Giovarruscio R, Febo A, Savarese E, Bisicchia S. Intercondylar eminence avulsion fracture in children: long-term follow-up of 14 cases at the end of skeletal growth. J Pediatr Orthop B 2010; 19 (05) 403-408
• 16 Mahar AT, Duncan D, Oka R, Lowry A, Gillingham B, Chambers H. Biomechanical comparison of four different fixation techniques for pediatric tibial eminence avulsion fractures. J Pediatr Orthop 2008; 28 (02) 159-162