Allograft Anterior Cruciate Ligament Reconstruction Utilizing Internal Brace Augmentation

Patellar Tendon Graft Anterior Cruciate Ligament Reconstruction Technique With Suture Tape Augmentation

Suture tape augmentation for repair and in combination with reconstruction with grafts has been described for multiple procedures. To date, no description of a patellar tendon graft anterior cruciate ligament reconstruction with an augmented graft has been published. This Technical Note details a technique we developed to incorporate a cross-linked suture tape into a patellar tendon graft.

Repair and Augmentation with Internal Brace in the Multiligament Injured Knee

The internal brace is a ligament repair bridging concept using braided ultra-high-molecular-weight polyethylene suture tape and knotless bone anchors to reinforce ligament strength to allow early mobilization during early-phase healing. This concept can be used in the management of anterior cruciate ligament, posterior cruciate ligament, anterolateral ligament, medial collateral ligament, posteromedial corner, and posterolateral corner injuries. Ligament reinforcement is a concept in which a graft is reinforced and can be used in all aspects of knee ligament reconstruction. There has been a recent resurgence in ligament repair and recent evidence suggests equivalent outcome results.

Augmentation of Anterior Cruciate Ligament Reconstruction With Bone Marrow Concentrate and a Suture Tape

The use of biological agents in sports medicine is increasing rapidly. The use of bone marrow concentrate has recently increased in popularity owing to the presence of mesenchymal stem cells. These stem cells combined with Allosync Pure (Arthrex, Naples, FL) could lead to better incorporation and healing. The mixture of bone marrow concentrate and Allosync Pure can be used in anterior cruciate ligament reconstruction, and we have developed a technique to use it in the femoral tunnel and deliver the medium arthroscopically. In this article we present a technique for using suture tape augmentation (InternalBrace; Arthrex) through the interference screw during a bone-patellar tendon-bone anterior cruciate ligament reconstruction.

Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction With Independent Suture Tape Reinforcement

Anterior cruciate ligament (ACL) injuries are common among adolescent athletes and are rising with increased participation in higher level athletics at earlier ages. In these young patients, often with open physes, soft tissue grafts continue to be the primary graft choice for ACL reconstruction. Reinjury continues to be a concern in this high-risk age group, with failure rates 2 to 3 times higher than in adults. Recently, primary ACL reconstruction with suture tape augmentation/reinforcement has been described in both hamstring autografts and allografts. Purported advantages include protection of the graft during the revascularization and remodeling phase of incorporation. This Technical Note details a surgical technique of independent suture tape reinforcement during primary all soft tissue quadriceps tendon autograft ACL reconstruction using an all-inside technique.

Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation

The advent of suture tape augmentation has led to increased use in knee, elbow, and ankle ligament repairs and reconstructions. Recent biomechanical analysis of the use of suture tape augmentation have shown superior strength characteristics compared with repair or reconstruction alone. Despite its increased use in extra-articular ligament procedures, its use as an augment to anterior cruciate ligament reconstruction has not been widely described. This article details a simple technique to incorporate the use of suture tape augmentation during concurrent anterior cruciate ligament reconstruction using hamstring autograft.

Ultrasound-Guided Suture Tape Augmentation and Stabilization of the Medial Collateral Ligament

Management of medial collateral ligament (MCL) injuries usually consists of time and conservative management; however, patients are typically immobilized and need extensive time to return to sport. Although the MCL has been shown to have the ability to heal given time, surgical management is still sometimes needed to provide stability to the knee. Operative techniques vary in methodology, but are typically highly invasive and technically demanding. In the event of multiligamentous or severe injuries, reinforcing the MCL with an ultrahigh-strength, 2-mm-wide suture tape allows for early functional rehabilitation, permitting the native MCL tissue to heal and avoiding late reconstructions. This technical report details an ultrasound-guided technique for the percutaneous suture tape augmentation and stabilization of the MCL with or without repair. Ultrasound allows for anatomic percutaneous placement of the sockets, as opposed to landmark palpation guidance that has proven to be unreliable. This is a simple, quick procedure that provides instant stability to the MCL with or without operating on the ligament itself, allowing patients to return to activity faster with the reduced risk of reinjury due to less muscle atrophy and loss of function.

The Crossing Internal Suture Augmentation Technique to Protect the All-Inside Anterior Cruciate Ligament Reconstruction Graft

The crossing internal suture augmentation technique is an all-inside technique of anterior cruciate ligament reconstruction with augmentation of the hamstring tendon autograft with a braided ultrahigh-molecular-weight polyester-polyethylene suture tape resting on the adjustable cortical buttons on both the femoral and tibial sides. The internal suture augmentation acts as a backbone supporting and protecting the graft until the process of healing and ligamentization of the graft is completed. The ends of the suture tape are tied on the tibial button and additionally fixed to the tibia with a knotless anchor as a backup fixation with the knee in full extension. The technique has the advantages of being minimally invasive with small incisions and allowing preservation of the bone stock through the use of sockets. It also allows early return to activity thanks to the more secure rehabilitation and prevents early failure and stretching of the graft.

Internal Suture Augmentation Technique to Protect the Anterior Cruciate Ligament Reconstruction Graft

The anterior cruciate ligament suture augmentation technique is a method to augment anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendons using a braided ultrahigh-molecular weight polyester or polyethylene suture or suture tape and fixed on both the femoral and tibial sides independent of the graft to act as a backup or secondary stabilizer until complete integration and ligamentization of the graft take place. The technique is proposed to allow early rehabilitation and return to sports after ACLR and may be advantageous in patients with a high body mass index and in cases with small grafts (7 or 7.5 mm in diameter). In such situations the technique is supposed to decrease the risk of reinjury, as well as the degree of postoperative lengthening or stretching of the graft, in the early postoperative avascular phase. We describe graft preparation with the internal suture augmentation technique in arthroscopic ACLR using a cortical button system on the femoral side and a Bio-Interference Screw (Arthrex, Naples, FL) on the tibial side.

Management of Anterior Cruciate Ligament Injury: What's In and What's Out?

Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.