Biomechanical characteristics of suturing the ligament end during anterior cruciate ligament reconstruction / 中国组织工程研究

ABSTRACT

BACKGROUND:During autologous tendon grafting, the ultimate tensile strength used for suturing the end of the ligament is important for successful surgery. Improving suturing strength and increasing the number of stitches is a good choice for increasing the fixed intensity. But excess amount of stitches can produce too many thread residues, thereby affecting tendon healing. OBJECTIVE:To investigate the essential number of suturing pins for the anterior cruciate ligament revascularization in ligament end suture fixation to reduce suturing thread exposure. METHODS:(1) In vitro biomechanics test12 patel ar ligament specimens were divided into two groupsthe specimens were sutured with 5 or 3 stitches using Krackow suture method. The suturing thread was J&J tendon suture thread. The strength of tensile was compared between the two groups by Tensile mechanical test was conducted to compare the strength of tensile between the two groups and to explore the optimal number of stitches and suturing method. (2) Clinical applicationAccording to the results of in vitro experiments, modified Krackow suture method was used clinical y for arthroscopic anterior cruciate ligament reconstruction in 125 cases, including 62 cases receiving 3-stitch suture, and 63 cases undergoing 5-stitch suture. RESULTS AND CONCLUSION:The fixed strength of tensile at suture sites was over 100 N for 3-stitch double-lock suture and 110 N for 5-stitch double-lock suture. There was no significant difference in the fixed strength between the two groups, but their strength values were both over the breaking strength of suturing materials. Moreover, the fixed strength could not be reduced by suturing throughout the ligament at the first stitch. Al the 125 cases were fol owed for 6.4 months averagely, and both 3-stitch and 5-stitch suture methods achieved good outcomes. The satisfaction rate was up to 99%, and no suture breakage or loosing occurred at early and late stages. These findings suggest that, using 3-stitch double-lock suture method, a satisfactory fixed strength can be achieved with reduced thread exposure. The suturing thread can run through the ligament at the first stitch, which can reduce thread exposure but not reduce the fixed strength.