Abstract
Graft strength is only one of the factors influencing anterior cruciate ligament (ACL) graft choice. However, it has a direct bearing on ultimate stability, which is the goal of ACL. The relative strengths of potential ACL grafts are often not clearly appreciated. It is the purpose of this chapter to present the available data on the relative strengths of tendons that can be used as ACL reconstructive grafts.
Introduction
Graft strength is only one of the factors influencing anterior cruciate ligament (ACL) graft choice. However, it has a direct bearing on ultimate stability, which is the goal of ACL reconstruction. The relative strengths of potential ACL grafts are often not clearly appreciated. It is the purpose of this chapter to present the available data on the relative strengths of tendons that can be used as ACL reconstructive grafts.
Introduction
Graft strength is only one of the factors influencing anterior cruciate ligament (ACL) graft choice. However, it has a direct bearing on ultimate stability, which is the goal of ACL reconstruction. The relative strengths of potential ACL grafts are often not clearly appreciated. It is the purpose of this chapter to present the available data on the relative strengths of tendons that can be used as ACL reconstructive grafts.
Methods
Table 13.1 summarizes the data that we were able to find in the literature on graft strengths. Load to failure (LTF) is the parameter compared in each case. This data was found from computerized literature searches targeting ACL reconstruction and each of the specific grafts in clinical use. Although some tissue banks have performed their own studies on graft strengths, we have purposely excluded such proprietary data and relied only on data published in peer-reviewed literature to avoid bias.
| Author | Year | Graft | Average Load to Failure (N) | Standard Deviation |
|---|---|---|---|---|
| Allografts | ||||
| Haut et al. | 2002 | Double anterior tibialis | 4122.0 | 893.0 |
| Pearsall et al. | 2003 | Double anterior tibialis | 3412.0 | NR |
| Pearsall et al. | 2003 | Double peroneus | 2483.0 | NR |
| Haut et al. | 2002 | Double post tibialis | 3594.0 | 1330.0 |
| Pearsall et al. | 2003 | Double post tibialis | 3391.0 | NR |
| King et al. | 2004 | Achilles | 1470.0 | 511.9 |
| King et al. | 2004 | Tibialis | 1806.7 | 496.2 |
| Semitendinosus (ST) | ||||
| Brahmabhatt et al. | 1999 | Double ST | 1029.0 | 158.4 |
| Hamner et al. | 1999 | Double ST | 2330.0 | 452.0 |
| King et al. | 2004 | Double ST | 1640.7 | 236.5 |
| Handl et al. | 2007 | Double ST | 3395 | 592 |
| Noyes et al. | 1984 | Single ST | 1216.0 | 50.0 |
| Hamner et al. | 1999 | Single ST | 1060.0 | 227.0 |
| Handl et al. | 2007 | Single ST | 2050 | 159 |
| Pailhé et al. | 2015 | Quadrupled ST | 630.82 | 239.15 |
| Gracilis (Gr) | ||||
| Brahmabhatt et al. | 1999 | Double Gr | 648.7 | 112.4 |
| Hamner et al. | 1999 | Double Gr | 1550.0 | 428.0 |
| Handl et al. | 2007 | Double Gr | 2573 | 496 |
| Noyes et al. | 1984 | Single Gr | 838.0 | 30.0 |
| Hamner et al. | 1999 | Single Gr | 837.0 | 138.0 |
| Handl et al. | 2007 | Single Gr | 925 | 127 |
| Pailhé et al. | 2015 | Quadrupled Gr | 416.41 | 187.68 |
| Cavaignac et al. | 2016 | Quadrupled Gr | 416.4 | 187.7 |
| Double ST/Double Gr (2ST/2Gr) | ||||
| Brahmabhatt et al. ∗ | 1999 | 2ST/2Gr | 1678.0 | NR |
| Noyes ∗ | 1984 | 2ST/2Gr | 4108.0 | NR |
| Hamner et al. | 1999 | 2ST/2Gr | 4090.0 | 295.0 |
| Kim et al. | 2003 | 2ST/2Gr | 3000.0 | 563.0 |
| Millett et al. | 2003 | 2ST/2Gr | 3404.2 | 922.0 |
| Haut et al. | 2002 | 2ST/2Gr | 2913.0 | 645.0 |
| Kim et al. | 2003 | 2ST/2Gr—braided | 1673.0 | 504.0 |
| Millett et al. | 2003 | 2ST/2Gr—braided | 2223.5 | 1056.0 |
| Pailhé et al. | 2015 | 2ST/2Gr (sutured full length) | 473.49 | 176.90 |
| Cavaignac et al. | 2016 | 2ST/2Gr | 473.5 | 176.9 |
| Handl et al. | 2007 | 2ST/2Gr | 4546 | 1500 |
| Bone–Patellar Tendon–Bone (BPTB) | ||||
| Noyes et al. | 1984 | 15-mm BPTB (medial third) | 2734.0 | 298.0 |
| Noyes et al. | 1984 | 15-mm BPTB (central third) | 2900.0 | 260.0 |
| Harris et al. | 1997 | 10-mm BPTB | 876.0 | NR |
| Brahmabhatt et al. | 1999 | 10-mm BPTB | 850.0 | 159.2 |
| King et al. | 2004 | 10-mm BPTB | 863.9 | 417.4 |
| Noyes et al. | 1984 | 10-mm BPTB (medial third) | 1822.7 | NR |
| Noyes et al. | 1984 | 10-mm BPTB (central third) | 1933.3 | NR |
| Cooper et al. | 1993 | 10-mm BPTB | 2664.0 | 395.0 |
| Cooper et al. | 1993 | 10-mm BPTB | 3057.0 | 351.0 |
| Pailhé et al. | 2015 | 10-mm BPTB | 319.56 | 92.04 |
| Pailhé et al. | 2015 | 10-mm BPTB (sutured full length) | 416.29 | 120.41 |
| Cavaignac et al. | 2016 | 10-mm BPTB | 413.3 | 120.4 |
| Handl et al. | 2007 | 10-mm BPTB | 3855 | 550 |
| Quadriceps | ||||
| Brahmabhatt et al. | 1999 | Quadriceps/bone | 991.0 | 282.0 |
| Harris et al. | 1997 | Quadriceps/bone | 1075.0 | NR |
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