Modified technique for preparation and placement of quadrupled semitendinosus autograft in anterior cruciate ligament reconstruction

Abstract

Purpose To improve technique of cortical fixation of quadrupled semitendinosus autograft in anterior cruciate ligament (ACL) reconstruction providing a tight contact of the tendon and bone inside the tunnels. Material and methods Application of the technique offered earlier for preparation and placement of quadrupled semitendinosus autograft in ACL reconstruction for a maximal tendon-bone contact is reviewed. The technique uses cortical buttons for semitendinosus graft fixation. Proximal and distal ends of the graft are corrugated at placement, thus increasing the diameter and providing additional fixation inside the bone tunnels. The modified technique employs same corrugated sutures with an easier placement practice. Potential fixation tightness in the tunnels is assessed by an increase in the diameter at both ends of the prepared graft while tightening corrugated sutures. Six semitendinosus tendons of 3 cadavers were used for testing. Results Diameters of the proximal and distal ends of the graft prepared with modified technique increased by 1.33 ± 0.52 mm and 1.5 ± 0.55 mm, respectively, at tightening the corrugated sutures. The ends of the corrugated sutures were tightened with a force of 50 N with a tension of 80 N applied to the graft. Elastic deformation was observed at 364.83 ± 69.16 N during the tensile test for the graft prepared with earlier technique and cortical fixation thread with the focus on the strength of transverse threads. The modified technique ensured a reliable construct being comparable with that provided by all-inside technique (760 N) by removing the weak link. Tendon graft preparation time reduced by 30 %. Conclusion Modification of the earlier described technique for preparation and placement of quadrupled semitendinosus autograft facilitated tight contact of the tendon and bone inside the tunnels, easier placement practice and improved strength characteristics of the prepared graft.

Keywords

• anterior cruciate ligament reconstruction
• fixation technique
• hamstring tendons
• quadrupled semitendinosus autograft