A nonparallel,nonisometric synthetic graft augmentation of a patellar tendon anterior cruciate ligament reconstruction

Abstract

The potential for a rigidly fixed synthetic graft placed in the over-the-top position to be stress shielding/stress sharing with the patellar tendon autograft was as sessed in a primate model. A patellar tendon autograft was placed anatomically and tensioned at 2 pounds for all of the groups. In the augmented animals, a 30 strand braided graft 10 cm in length of expanded polytetra fluoroethylene was tightened with the knee in full ex tension. After 6 months of unrestricted cage activity the animals were sacrificed and biomechanical testing performed. The augmented patellar tendon autografts demonstrated less laxity in extension as compared to the autografts alone. A minimal decrease in the load and stiffness to failure for the augmented groups as compared to the nonaugmented knees was noted. However, both the reconstruction groups had a signif icant decrease in the load to failure at 6 months (50% of the normal ACL).

In summary, this study demonstrated that a synthetic graft augmentation can be performed in the over-the- top position and minimize knee laxity, especially during terminal extension. With this technique, the laxity was minimized while the incorporation and strengthening of the biologic autograft occurred at a rate similar to the unaugmented reconstruction.