The Effect of Length on the Structural Properties of an Achilles Tendon Graft as Used in Posterior Cruciate Ligament Reconstruction

Background The clinical outcomes of posterior cruciate ligament reconstruction are varied. No previous studies have investigated the effect of graft length on the structural properties of the graft. Hypothesis Graft length significantly affects the structural properties of posterior cruciate ligament grafts. Study Design Controlled laboratory study. Methods Eight Achilles tendon grafts were tested under tensile loads up to 400 N at 3 different lengths: long (75 mm), medium (48 mm), and short (34 mm). These 3 lengths represent midtunnel fixation, inlay fixation, and fixation near the ligament insertions. Results Shortening the graft from both long to medium and from medium to short increased the stiffness by approximately 25%. Long and medium grafts displaced significantly more than medium and short grafts, respectively. Conclusion The effective length of a graft, which is determined by where it is fixed, should be considered an important variable in posterior cruciate ligament reconstruction.

[1]  B. Reider,et al.  The Effect of Femoral Tunnel Position and Graft Tensioning Technique on Posterior Laxity of the Posterior Cruciate Ligament-Reconstructed Knee , 1995, The American journal of sports medicine.

[2]  G. Lewis,et al.  Tensile properties of human tendo Achillis: effect of donor age and strain rate. , 1997, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[3]  K. Markolf,et al.  Biomechanical Comparison of Tibial Inlay and Tibial Tunnel Techniques for Reconstruction of the Posterior Cruciate Ligament: Analysis of Graft Forces , 2002, The Journal of bone and joint surgery. American volume.

[4]  G. Lewis,et al.  Modeling the tensile behavior of human Achilles tendon. , 1997, Bio-medical materials and engineering.

[5]  T. Gill,et al.  The Biomechanical Effect of Posterior Cruciate Ligament Reconstruction on Knee Joint Function , 2003, The American journal of sports medicine.

[6]  C. Frank,et al.  Medial collateral ligament autografts have increased creep response for at least two years and early immobilization makes this worse , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[7]  A. Amis,et al.  The mechanical properties of the two bundles of the human posterior cruciate ligament. , 1994, Journal of biomechanics.

[8]  S. Woo,et al.  The Human Posterior Cruciate Ligament Complex: An Interdisciplinary Study , 1995, The American journal of sports medicine.

[9]  J. Buckwalter,et al.  Athletics and Osteoarthritis , 1997, The American journal of sports medicine.

[10]  Paolo P. Provenzano,et al.  Nonlinear Ligament Viscoelasticity , 2001, Annals of Biomedical Engineering.

[11]  K. Markolf,et al.  Cyclic Loading of Posterior Cruciate Ligament Replacements Fixed with Tibial Tunnel and Tibial Inlay Methods , 2002, The Journal of bone and joint surgery. American volume.

[12]  Richard E. Debski,et al.  Structure and Function of the Healing Medial Collateral Ligament in a Goat Model , 2001, Annals of Biomedical Engineering.

[13]  S. Woo,et al.  The Effect of Knee Flexion Angle and Application of an Anterior Tibial Load at the Time of Graft Fixation on the Biomechanics of a Posterior Cruciate Ligament-Reconstructed Knee , 2000, The American journal of sports medicine.

[14]  A. Anderson,et al.  Isolated posterior cruciate ligament reconstruction , 1993 .

[15]  Freddie H. Fu,et al.  The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. , 1997, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[16]  K. Markolf,et al.  Biomechanical effects of medial–lateral tibial tunnel placement in posterior cruciate ligament reconstruction , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[17]  A. Amis,et al.  PCL reconstruction. In vitro biomechanical comparison of 'isometric' versus single and double-bundled 'anatomic' grafts. , 1998, The Journal of bone and joint surgery. British volume.

[18]  N. Choi,et al.  Tensile and viscoelastic properties of human patellar tendon , 1994, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[19]  S L Woo,et al.  Biomechanical Analysis of a Double-Bundle Posterior Cruciate Ligament Reconstruction* , 2000, The American journal of sports medicine.

[20]  F. Noyes,et al.  Two-Bundle Posterior Cruciate Ligament Reconstruction , 2000, The American journal of sports medicine.

[21]  G. Beaupré,et al.  Mechanical properties of the human achilles tendon. , 2001, Clinical biomechanics.

[22]  M M Panjabi,et al.  Subfailure injury affects the relaxation behavior of rabbit ACL. , 1999, Clinical biomechanics.

[23]  F. Noyes,et al.  Posterior Cruciate Ligament Reconstruction , 1996, The American journal of sports medicine.

[24]  R. Parker,et al.  A Biomechanical Comparison of Posterior Cruciate Ligament Reconstruction Techniques * , 2001, The American journal of sports medicine.

[25]  K. Markolf,et al.  A Biomechanical Study of Replacement of the Posterior Cruciate Ligament with a Graft. Part I: Isometry, Pre-Tension of the Graft, and Anterior-Posterior Laxity* , 1997, The Journal of bone and joint surgery. American volume.

[26]  J. Robert Giffin,et al.  Single- versus double-bundle PCL reconstruction: a biomechanical analysis. , 2002, The journal of knee surgery.

[27]  Jeremy Suggs,et al.  Determination of optimal graft lengths for posterior cruciate ligament reconstruction--a theoretical analysis. , 2003, Journal of biomechanical engineering.

[28]  G S Beaupré,et al.  Influence of bone mineral density, age, and strain rate on the failure mode of human Achilles tendons. , 2001, Clinical biomechanics.

[29]  Louis F Draganich,et al.  The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on the Contact Characteristics of the Patellofemoral Joint , 2002, The American journal of sports medicine.