Suture Tape Augmentation Increases the Time-Zero Stiffness and Strength of Anterior Cruciate Ligament Grafts: A Cadaveric Study.

Purpose: To determine the postsurgical strength and stiffness of anterior cruciate ligament (ACL) reconstructions with (ACLR-SA) and without suture tape augmentation (ACLR) in a human cadaveric model. Methods: Eight matched pairs of cadaveric knees were tested intact and after bone-patellar tendon-bone ACL reconstruction. Specimens were potted and loaded onto a mechanical testing system, and an anterior drawer force of 88N was applied at 0°, 15°, 30°, 60°, and 90° of flexion. Specimens were then loaded to failure, with clinical failure defined as anterior translation greater than 10 mm. Results: ACL-intact knees translated an average of 4.99 ± 0.28 mm across all flexion angles when an 88N anterior load was applied. ACLR knees had significantly greater translation compared to intact specimens. ACLRs with suture augmentation had less of an increase (0.67 mm, 95% confidence interval [CI]: 0.20, 1.14, P < .01) than those without suture augmentation (1.42 mm, 95% CI: 0.95, 1.89, P < .001). ACLR-SA required greater anterior load (170.4 ± 38.1 N) to reach clinical failure compared to ACLR alone (141.8 ± 51.2 N), P = .042. In addition, stiffness of ACLR-SA constructs (23.5 ± 3.3) were significantly greater than ACLR alone (20.3 ± 3.9), P = .003. Conclusion: Augmentation of ACLR with suture tape allowed full range of motion with improved graft stiffness and increased failure load compared to unaugmented ACLR in this time-zero study. Clinical Relevance: Internal bracing may help reinforce ACLR grafts and allow for acceleration of rehabilitation protocols and earlier return to activity.

Ulnar Collateral Ligament Repair of the Elbow-Biomechanics, Indications, and Outcomes.

PURPOSE OF REVIEW: Traditionally medial elbow injuries in overhead athletes have been treated with ulnar collateral ligament (UCL) reconstruction as first described by Dr. Frank Jobe. Recent literature has shown favorable outcomes in select patients treated with UCL repair. Newer techniques utilizing suture augmentation demonstrate biomechanical profiles as good or better than the native state and/or reconstruction. This review aims to evaluate these biomechanical studies and the clinical outcomes of ulnar collateral ligament repair with suture augmentation. RECENT FINDINGS: UCL repair has favorable outcomes in select patients with specific tear type patterns. Clinical outcomes have shown return to play rates of 92-97% with mean time of 2.5-6 months post-operatively. Biomechanical data comparing UCL repair to reconstruction techniques have shown improved resistance to common forces applied to the elbow during overhead activities. Additionally, suture tape augmentation dramatically improves stability of ligament repair without over-constraining the elbow. Initial ulnar collateral ligament repair data was poor, and thus UCL reconstruction became the mainstay of treatment for overhead athletes. Recent studies evaluating the biomechanical properties as well as clinical outcomes have demonstrated favorable data when UCL repair is performed. When considering the drawbacks of a prolonged recovery associated with reconstruction, UCL repair is a viable option in select patients.

Arthroscopic Hip Capsular Plication With Augmentation Using a Bioinductive Collagen Implant.

With advancements in arthroscopic techniques and instrumentation, hip arthroscopy has become an increasingly used technique to treat soft-tissue and osseous pathologies about the hip. Patient predisposition to labral and capsular injuries can present as femoroacetabular impingement or hip dysplasia, sometimes in combination. Capsular management continues to be a topic of debate, with capsular repair becoming the standard of care in most cases. Furthermore, in cases of borderline dysplasia and microinstability, considerations for not only capsular repair but with plication has shown significant clinical success. Although plication in this setting has shown promise, given a 20% failure rate, we suggest capsular augmentation to bolster the repair. We present a technique of capsular augmentation using a bioinductive collagen implant (Smith & Nephew) to improve the capsular integrity following repair and plication. The benefits of this implant are easy delivery through standard arthroscopic portals and secure fixation to the capsular tissue. These implants have a proven track record in the shoulder and serve as a scaffold for improved tissue quality, and their application in hip arthroscopy has potential by increasing the integrity of the capsular repair. Future studies are needed to address the clinical outcomes of this technique.