title: Primary stability of three posterior cruciate ligament reconstruction procedures: a biomechanical in vitro study.
abstract: OBJECTIVE
  Posterior cruciate ligament (PCL) reconstruction procedures have not been thoroughly evaluated under cyclic loading conditions. We tested the hypothesis that PCL reconstruction with a quadrupled flexor-tendon graft and fixation using tapes and staples is biomechanically superior to that fixed with sutures, a button, and a post-screw, and is comparable to reconstruction with a bone--patellar tendon--bone (BPTB) graft.
  
  
  METHODS
  In vitro biomechanical study.
  
  
  METHODS
  A total of 45 porcine knees were used. The quadrupled flexor-tendon graft was fixed using the suture/button/post-screw procedure in 15 knees, and with the tape/staples procedure in another 15 knees. The remaining 15 knees underwent reconstruction with a BPTB graft secured with screws as the standard control. In each group of 15 knees, 5 underwent tensile testing without cyclic loading, and 10 underwent the same tensile test after 5,000 cycles of load-controlled or displacement-controlled loading.
  
  
  RESULTS
  Each type of cyclic loading produced larger biomechanical changes in the knees fixed with the suture/button/post-screw procedure than in the knees secured using the other 2 procedures.
  
  
  CONCLUSIONS
  In PCL reconstruction, the tape/staples procedure is biomechanically superior to the suture/button/post-screw procedure, and is comparable to the BPTB/screws procedure with regard to the ultimate failure load. Neither of the procedures using the quadrupled flexor-tendon graft was comparable to the BPTB graft in linear stiffness and the initial displacement after load-controlled cyclic testing.
  
  
  CONCLUSIONS
  The biomechanical behaviors of PCL-reconstructed knees are significantly different, depending on surgical techniques.
authors.affiliation: Department of Sports Medicine and Joint Reconstruction Surgery, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: Nobuto
authors.initials: N
authors.lastname: Kitamura
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yasuda
authors.forename: Harukazu
authors.initials: H
authors.lastname: Tohyama
authors.forename: Masanori
authors.initials: M
authors.lastname: Yamanaka
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Tanabe
mesh_terms: D000818:Animals; D001182:Arthroscopy / Q000379:methods*; D001696:Biomechanical Phenomena; D001863:Bone Screws; D004868:Equipment Failure; D005269:Femur / Q000601:surgery / Q000637:transplantation*; D020007:Implants, Experimental; D008422:Materials Testing; D017847:Patellar Ligament / Q000637:transplantation*; D011091:Polyesters; D016119:Posterior Cruciate Ligament / Q000293:injuries / Q000601:surgery*; D019736:Prostheses and Implants; D011897:Random Allocation; D017792:Surgical Stapling; D034421:Sus scrofa; D013536:Suture Techniques; D013537:Sutures; D013710:Tendons / Q000637:transplantation*; D013718:Tensile Strength; D013977:Tibia / Q000601:surgery / Q000637:transplantation*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016474:Weight-Bearing
chemical_list: D011091:Polyesters