title: Preparation techniques for all-inside ACL cortical button grafts: a biomechanical study.
abstract: OBJECTIVE
  Performing all-inside anterior cruciate ligament reconstruction using cortical button fixation, the tendon graft has to be secured in a closed loop with sutures. In the present study, the graft secured with four sutures was compared with two reduced-suture material graft preparation techniques.
  
  
  METHODS
  A bovine tendon graft folded over two adjustable-length loop cortical button devices was secured using the following techniques: 1, four buried-knot sutures; 2, two sutures on the tibial end only; and 3, two sutures on the tibial graft end with additional suspension on the tibial cortical button. Each group consisted of eight specimens and underwent cyclic loading followed by a load-to-failure test.
  
  
  RESULTS
  The least graft elongation after cyclic loading was observed for the graft with four sutures (6.1 ± 0.6 mm), followed by the graft with two sutures and additional suspension (6.3 ± 0.8 mm) and the graft with two sutures (7.0 ± 0.7 mm). The difference in graft elongation between four sutures and only two sutures was significant (P < 0.05). The ultimate failure loads were highest for the graft with two sutures and additional suspension (801 ± 107 N), followed by the graft with four sutures (766 ± 70 N), and the graft with two sutures (699 ± 87 N). No significant (n.s.) differences were observed between the ultimate failure loads in the three groups.
  
  
  CONCLUSIONS
  For the reduction in suture material to two sutures, additional suspension can be used in order to reduce the graft lengthening. Performing a suture-reducing graft can save operating time and costs. However, each of the three all-inside button graft techniques showed considerable graft elongation indicating a risk of graft lengthening in the early postoperative period.
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: Raul
authors.initials: R
authors.lastname: Mayr
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: Christian Heinz
authors.initials: CH
authors.lastname: Heinrichs
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Eichinger
authors.affiliation: AUVA Trauma Center Klagenfurt, Waidmannsdorferstrasse 35, 9021, Klagenfurt, Austria.
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Smekal
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
authors.forename: Werner
authors.initials: W
authors.lastname: Schmoelz
authors.affiliation: Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. rene.attal@uki.at.
authors.forename: René
authors.initials: R
authors.lastname: Attal
mesh_terms: D000818:Animals; D000070598:Anterior Cruciate Ligament Injuries / Q000503:physiopathology / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001696:Biomechanical Phenomena; D002417:Cattle; D013536:Suture Techniques; D013710:Tendons / Q000502:physiology* / Q000637:transplantation*; D013718:Tensile Strength
keywords: ACL reconstruction; All-inside; Anterior cruciate ligament; Biomechanics; Cortical fixation; Hamstring graft