Allograft Anterior Cruciate Ligament Reconstruction Utilizing Internal Brace Augmentation

Abstract

Anterior cruciate ligament (ACL) tears are among the most common sports-related injuries. Although studies have reported reliable outcomes with allograft tissue, several studies have shown a higher failure rate in younger patients. Although ACL graft augmentation has been met with varying levels of success, internal bracing of an allograft represents a promising area in ACL reconstruction. The purpose of this article is to detail allograft preparation involving a collagen-coated, ultrahigh-molecular-weight polyethylene/polyester suture tape as an internal brace augmentation for ACL reconstruction using the all-inside ACL GraftLink Technique (Arthrex, Naples, FL).

Figures

Fig 1

Graft prep station with the NoButton TightRope loop for the tibial fixation seen on the right, and the TightRope RT loop for femoral fixation seen on the left. The anterior tibialis allograft (red arrow) to be prepared is on the white board in the foreground.

Fig 2

The anterior tibialis graft is first passed through the tibial NoButton TightRope loop (left arrow). The collagen-coated FiberTape is next passed through the femoral TightRope loop (right arrow).

Fig 3

The final construct of the quadrupled anterior tibialis allograft secured by the 4 wrap-around no. 2 Fiberwire sutures. The internal brace collagen-coated FiberTape is only visible with the 2 free ends exiting out the tibial end of the graft (left, arrow).

Fig 4

The patient is lying supine with the knee flexed at 90°. The right knee is shown with the completed quadrupled anterior tibialis allograft anterior cruciate ligament construct after suspensory TightRope fixation on the femur and tibia. Again, the internal brace collagen-coated FiberTape is fully contained within the graft such that no part of the FiberTape is visible inside the joint space.

Fig 5

The patient remains in the supine position, and the knee is held in full hyperextension. The collagen-coated FiberTape internal brace is independently tensioned and fixated on the tibia after the anterior cruciate ligament graft fixation is completed on the tibial side. First, a hemostat is placed underneath the 2 free ends of the collagen-coated FiberTape (white arrow). Next the FiberTape ends are secured to the tibia with a biocomposite SwiveLock (Arthrex, Naples, FL) (black arrow) in full hyperextension.