title: [Ligament bracing--augmented cruciate ligament sutures: biomechanical studies of a new treatment concept].
abstract: BACKGROUND
  In the context of acute knee dislocations, suture repair of ruptured cruciate ligaments leads to good clinical results in 80% of cases. Disadvantages are low primary stability and subsequently secondary elongation of the sutured ligaments. In the present study, we compared primary stability of suture repair, reinforced by different suture augments, to cruciate ligament reconstruction.
  
  
  OBJECTIVE
  The concept of ligament bracing with transosseous suture repair of the cruciate ligaments and additional suture augmentation is biomechanically superior to cruciate ligament reconstruction.
  
  
  METHODS
  A total of 42 porcine knee joints divided into seven groups were examined. The stability of four different suture/augmentation combinations were compared to cruciate ligament reconstruction with human hamstring tendons. The investigational setup consisted of testing 1000 cycles with 20 N to 154 N load in a.-p. translation and 60° flexion. Elongation and load to failure were measured.
  
  
  RESULTS
  Neither reconstruction (3.13 ± 1.65 mm; 362 ± 51 N) nor augmented suture repair (1.89-2.5 mm; 464-624 N) achieved the primary stability of the intact cruciate ligament (0.63 ± 0.34 mm, 1012 ± 91 N). In comparison to ligament reconstruction, all four augmented suture repairs showed minor elongation in the cyclic test and a higher load to failure. The isolated suture repair showed poor results (6.79 ± 4.86 mm, 177 ± 73 N).
  
  
  CONCLUSIONS
  Augmented suture repair provides significantly higher stability compared with isolated suture repair and reconstruction with hamstring tendons. The concept of ligament bracing could be a promising future treatment option in acute knee dislocations. Clinical results remain to be seen.
authors.affiliation: Chirurgisch-Traumatologisches Zentrum, Asklepios Klinik St.Georg, Lohmühlenstraße 5, 20099, Hamburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Heitmann
authors.forename: A
authors.initials: A
authors.lastname: Dratzidis
authors.forename: M
authors.initials: M
authors.lastname: Jagodzinski
authors.forename: P
authors.initials: P
authors.lastname: Wohlmuth
authors.forename: C
authors.initials: C
authors.lastname: Hurschler
authors.forename: K
authors.initials: K
authors.lastname: Püschel
authors.forename: A
authors.initials: A
authors.lastname: Giannakos
authors.forename: A
authors.initials: A
authors.lastname: Preiss
authors.forename: K-H
authors.initials: KH
authors.lastname: Frosch
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000503:physiopathology* / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D006801:Humans; D066298:In Vitro Techniques; D013314:Stress, Mechanical; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013552:Swine; D013718:Tensile Strength