Bone-Patellar Tendon-Bone Graft Preparation for Fixation with Suspensory Method in Anterior Cruciate Reconstruction: A Biomechanical Study

Many grafts are used for ACL reconstruction with different methods of fixation. We have presented a new technique for BTB (bone-tendon-bone) graft preparation and compared its biomechanical properties with the classic one to see if the suspensory method of fixation is applicable for BTB grafts.
Eight fresh frozen human BTB grafts were prepared. Grafts were randomly divided into two separate groups. Each containing 4 grafts. In the first group grafts were prepared with standard BTB graft method and in the second group grafts were prepared with new enfolded method. All the grafts were assembled in a universal testing machine for testing the mechanical properties of the grafts. Maximum tensile strength, failure load and failure mode were derived from machine and the values were compared in each group.
Mean failure load for classic group was 1660.25 and for enfolded group it was 1579.25 (P = 0.25). Mean stiffness for classic group was 285.25 N/meter and for enfolded group it was 268.75 N/ per meter (P = 0.1). In classic group, all failures happened at the bone-ligament junction. In the enfolded group, failures also occurred through the tendino-osseous junction except for one case.
Enfolded BTB graft preparation had the same biomechanical indexes of classic method. Therefore this graft preparation method can be used for ACL ligament reconstruction surgery with used of suspensory fixation by Endobutton.