The Journal of Bone and Joint Surgery, Vol 66, Issue 3 344-352, Copyright © 1984 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions

FR Noyes, DL Butler, ES Grood, RF Zernicke and MS Hefzy

Virtually all types of collagenous tissues have been transferred in and around the knee joint for intra-articular and extra-articular ligament reconstructions. However, the mechanical properties (in particular, strength) of such grafts have not been determined in tissues from young adult donors, where age and disuse-related effects have been excluded. To provide this information, we subjected ligament graft tissues to high-strain-rate failure tests to determine their strength and elongation properties. The results were compared with the mechanical properties of anterior cruciate ligaments from a similar young-adult donor population. The study indicated that some graft tissues used in ligament reconstructions are markedly weak and therefore are at risk for elongation and failure at low forces. Grafts utilizing prepatellar retinacular tissues (as in certain anterior-cruciate reconstructions) and others in which a somewhat narrow width of fascia lata or distal iliotibial tract is utilized are included in this at-risk group. Wider grafts from the iliotibial tract or fascia lata would of course proportionally increase ultimate strength. The semitendinosus and gracilis tendons are stronger, having 70 and 49 per cent, respectively, of the initial strength of anterior cruciate ligaments. The bone-patellar tendon-bone graft (fourteen to fifteen millimeters wide, medial or central portion) was the strongest, with a mean strength of 159 to 168 per cent of that of anterior cruciate ligaments. Patellar tendon-bone units, based on grip-to-grip motions, were found to be three to four times stiffer than similarly gripped anterior cruciate ligaments, while gracilis and semitendinosus tendon preparations had values that were nearly identical to those of anterior cruciate ligaments.(ABSTRACT TRUNCATED AT 250 WORDS)
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				R. T. Ruland, C. J. Hogan, C. J. Randall, A. Richards, and S. M. Belkoff Biomechanical Comparison of Ulnar Collateral Ligament Reconstruction Techniques Am. J. Sports Med., August 1, 2008; 36(8): 1565 - 1570. [Abstract] [Full Text] [PDF]

				L. L. Greaves, A. T. Hecker, and C. H. Brown Jr The Effect of Donor Age and Low-Dose Gamma Irradiation on the Initial Biomechanical Properties of Human Tibialis Tendon Allografts Am. J. Sports Med., July 1, 2008; 36(7): 1358 - 1366. [Abstract] [Full Text] [PDF]

				K. L. Moffat, W.-H. S. Sun, P. E. Pena, N. O. Chahine, S. B. Doty, G. A. Ateshian, C. T. Hung, and H. H. Lu From the Cover: Characterization of the structure-function relationship at the ligament-to-bone interface PNAS, June 10, 2008; 105(23): 7947 - 7952. [Abstract] [Full Text] [PDF]

				J. Prud'homme, J. E. Budoff, L. Nguyen, and J. A. Hipp Biomechanical Analysis of Medial Collateral Ligament Reconstruction Grafts of the Elbow Am. J. Sports Med., April 1, 2008; 36(4): 728 - 732. [Abstract] [Full Text] [PDF]

				R. L. Bartz, K. Mossoni, J. Tyber, J. Tokish, K. Gall, and P. N. Siparsky A Biomechanical Comparison of Initial Fixation Strength of 3 Different Methods of Anterior Cruciate Ligament Soft Tissue Graft Tibial Fixation: Resistance to Monotonic and Cyclic Loading Am. J. Sports Med., June 1, 2007; 35(6): 949 - 954. [Abstract] [Full Text] [PDF]

				B. S. Dunkin, J. Nyland, A. R. Duffee, J. A. Brunelli, R. Burden, and D. Caborn Soft Tissue Tendon Graft Fixation in Serially Dilated or Extraction-Drilled Tibial Tunnels: A Porcine Model Study Using High-Resolution Quantitative Computerized Tomography Am. J. Sports Med., March 1, 2007; 35(3): 448 - 457. [Abstract] [Full Text] [PDF]

				J. A. Cooper Jr., J. S. Sahota, W. J. Gorum II, J. Carter, S. B. Doty, and C. T. Laurencin Biomimetic tissue-engineered anterior cruciate ligament replacement PNAS, February 27, 2007; 104(9): 3049 - 3054. [Abstract] [Full Text] [PDF]

				H. E. Schwartz, M. J. Matava, F. S. Proch, C. A. Butler, A. Ratcliffe, M. Levy, and D. L. Butler The Effect of Gamma Irradiation on Anterior Cruciate Ligament Allograft Biomechanical and Biochemical Properties in the Caprine Model at Time Zero and at 6 Months After Surgery Am. J. Sports Med., November 1, 2006; 34(11): 1747 - 1755. [Abstract] [Full Text] [PDF]

				P. W. Grutter and S. A. Petersen Anatomical Acromioclavicular Ligament Reconstruction: A Biomechanical Comparison of Reconstructive Techniques of the Acromioclavicular Joint Am. J. Sports Med., November 1, 2005; 33(11): 1723 - 1728. [Abstract] [Full Text] [PDF]

				N. Upadhyay, S. R. Vollans, B. B. Seedhom, and R. W. Soames Effect of Patellar Tendon Shortening on Tracking of the Patella Am. J. Sports Med., October 1, 2005; 33(10): 1565 - 1574. [Abstract] [Full Text] [PDF]

				R. F. LaPrade, T. S. Bollom, F. A. Wentorf, N. J. Wills, and K. Meister Mechanical Properties of the Posterolateral Structures of the Knee Am. J. Sports Med., September 1, 2005; 33(9): 1386 - 1391. [Abstract] [Full Text] [PDF]

				K. Marumo, M. Saito, T. Yamagishi, and K. Fujii The "Ligamentization" Process in Human Anterior Cruciate Ligament Reconstruction With Autogenous Patellar and Hamstring Tendons: A Biochemical Study Am. J. Sports Med., August 1, 2005; 33(8): 1166 - 1173. [Abstract] [Full Text] [PDF]

				H. C. Chang, J. Nyland, A. Nawab, R. Burden, and D. N. M. Caborn Biomechanical Comparison of the Bioabsorbable RetroScrew System, BioScrew XtraLok With Stress Equalization Tensioner, and 35-mm Delta Screws for Tibialis Anterior Graft-Tibial Tunnel Fixation in Porcine Tibiae Am. J. Sports Med., July 1, 2005; 33(7): 1057 - 1064. [Abstract] [Full Text] [PDF]

				M. Takao, K. Oae, Y. Uchio, M. Ochi, and H. Yamamoto Anatomical Reconstruction of the Lateral Ligaments of the Ankle With a Gracilis Autograft: A New Technique Using an Interference Fit Anchoring System Am. J. Sports Med., June 1, 2005; 33(6): 814 - 823. [Abstract] [Full Text] [PDF]

				R. V. West and C. D. Harner Graft Selection in Anterior Cruciate Ligament Reconstruction J. Am. Acad. Ortho. Surg., May 1, 2005; 13(3): 197 - 207. [Abstract] [Full Text] [PDF]

				A. Harvey, N. P. Thomas, and A. A. Amis Fixation of the graft in reconstruction of the anterior cruciate ligament J Bone Joint Surg Br, May 1, 2005; 87-B(5): 593 - 603. [Full Text] [PDF]

				R. S. J. Burnett, R. A. Berger, W. G. Paprosky, C. J. Della Valle, J. J. Jacobs, and A. G. Rosenberg Extensor Mechanism Allograft Reconstruction After Total Knee Arthroplasty. A COMPARISON OF TWO TECHNIQUES J. Bone Joint Surg. Am., December 1, 2004; 86(12): 2694 - 2699. [Abstract] [Full Text] [PDF]

				P. Aglietti, F. Giron, R. Buzzi, F. Biddau, and F. Sasso Anterior Cruciate Ligament Reconstruction: Bone-Patellar Tendon-Bone Compared with Double Semitendinosus and Gracilis Tendon Grafts. A Prospective, Randomized Clinical Trial J. Bone Joint Surg. Am., October 1, 2004; 86(10): 2143 - 2155. [Abstract] [Full Text] [PDF]

				C. S. Ahmad, T. R. Gardner, M. Groh, J. Arnouk, and W. N. Levine Mechanical Properties of Soft Tissue Femoral Fixation Devices for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., April 1, 2004; 32(3): 635 - 640. [Abstract] [Full Text] [PDF]

				D. H. Kim, D. R. Wilson, A. T. Hecker, T. M. Jung, and C. H. Brown Jr. Twisting and Braiding Reduces the Tensile Strength and Stiffness of Human Hamstring Tendon Grafts Used for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., November 1, 2003; 31(6): 861 - 867. [Abstract] [Full Text] [PDF]

				N. Kitamura, K. Yasuda, M. Yamanaka, and H. Tohyama Biomechanical Comparisons of Three Posterior Cruciate Ligament Reconstruction Procedures with Load-Controlled and Displacement-Controlled Cyclic Tests Am. J. Sports Med., November 1, 2003; 31(6): 907 - 914. [Abstract] [Full Text] [PDF]

				N. Verma, M. A. Noerdlinger, N. Hallab, C. A. Bush-Joseph, and B. R. Bach Jr. Effects of Graft Rotation on Initial Biomechanical Failure Characteristics of Bone-Patellar Tendon-Bone Constructs Am. J. Sports Med., September 1, 2003; 31(5): 708 - 713. [Abstract] [Full Text] [PDF]

				A. F. Anderson Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients: A Preliminary Report J. Bone Joint Surg. Am., July 3, 2003; 85(7): 1255 - 1263. [Abstract] [Full Text] [PDF]

				T. Tashiro, H. Kurosawa, A. Kawakami, A. Hikita, and N. Fukui Influence of Medial Hamstring Tendon Harvest on Knee Flexor Strength after Anterior Cruciate Ligament Reconstruction: A Detailed Evaluation with Comparison of Single- and Double-Tendon Harvest Am. J. Sports Med., July 1, 2003; 31(4): 522 - 529. [Abstract] [Full Text] [PDF]

				J. T. Nurmi, P. Kannus, H. Sievanen, M. Jarvinen, and T. L. N. Jarvinen Compaction Drilling Does Not Increase the Initial Fixation Strength of the Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction in a Cadaver Model Am. J. Sports Med., May 1, 2003; 31(3): 353 - 358. [Abstract] [Full Text] [PDF]

				P. Kousa, T. L. N. Jarvinen, M. Vihavainen, P. Kannus, and M. Jarvinen The Fixation Strength of Six Hamstring Tendon Graft Fixation Devices in Anterior Cruciate Ligament Reconstruction: Part I: Femoral Site Am. J. Sports Med., March 1, 2003; 31(2): 174 - 181. [Abstract] [Full Text] [PDF]

				H. Otsuka, Y. Ishibashi, E. Tsuda, K. Sasaki, and S. Toh Comparison of Three Techniques of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft: Differences in Anterior Tibial Translation and Tunnel Enlargement with Each Technique Am. J. Sports Med., March 1, 2003; 31(2): 282 - 288. [Abstract] [Full Text] [PDF]

				L. Ejerhed, J. Kartus, N. Sernert, K. Kohler, and J. Karlsson Patellar Tendon or Semitendinosus Tendon Autografts for Anterior Cruciate Ligament Reconstruction?: A Prospective Randomized Study with a Two-Year Follow-up Am. J. Sports Med., January 1, 2003; 31(1): 19 - 25. [Abstract] [Full Text] [PDF]

				H. Numazaki, H. Tohyama, H. Nakano, S. Kikuchi, and K. Yasuda The Effect of Initial Graft Tension in Anterior Cruciate Ligament Reconstruction on the Mechanical Behaviors of the Femur-Graft-Tibia Complex During Cyclic Loading Am. J. Sports Med., November 1, 2002; 30(6): 800 - 805. [Abstract] [Full Text] [PDF]

				J. O. Drogset and T. Grontvedt Anterior Cruciate Ligament Reconstruction with and without a Ligament Augmentation Device : Results at 8-Year Follow-up Am. J. Sports Med., November 1, 2002; 30(6): 851 - 856. [Abstract] [Full Text] [PDF]

				K. Moholkar, D. Taylor, M. O'Reagan, and G. Fenelon A Biomechanical Analysis of Four Different Methods of Harvesting Bone-Patellar Tendon-Bone Graft in Porcine Knees J. Bone Joint Surg. Am., October 10, 2002; 84(10): 1782 - 1787. [Abstract] [Full Text] [PDF]

				J. E. Tis, W. R. Klemme, K. L. Kirk, K. P. Murphy, and B. Cunningham Braided Hamstring Tendons for Reconstruction of the Anterior Cruciate Ligament: A Biomechanical Analysis Am. J. Sports Med., September 1, 2002; 30(5): 684 - 688. [Abstract] [Full Text] [PDF]

				L. S. Crossett, R. K. Sinha, V. F. Sechriest, and H. E. Rubash Reconstruction of a Ruptured Patellar Tendon with Achilles Tendon Allograft Following Total Knee Arthroplasty J. Bone Joint Surg. Am., August 12, 2002; 84(8): 1354 - 1361. [Abstract] [Full Text] [PDF]

				L. A. Pinczewski, D. J. Deehan, L. J. Salmon, V. J. Russell, and A. Clingeleffer A Five-Year Comparison of Patellar Tendon Versus Four-Strand Hamstring Tendon Autograft for Arthroscopic Reconstruction of the Anterior Cruciate Ligament Am. J. Sports Med., July 1, 2002; 30(4): 523 - 536. [Abstract] [Full Text] [PDF]

				N. L. Harris, P. A. Indelicato, M. S. Bloomberg, K. Meister, and D. L. Wheeler Radiographic and Histologic Analysis of the Tibial Tunnel after Allograft Anterior Cruciate Ligament Reconstruction in Goats Am. J. Sports Med., May 1, 2002; 30(3): 368 - 373. [Abstract] [Full Text] [PDF]

				M. D. Shaieb, D. M. Kan, S. K. Chang, J. M. Marumoto, and A. B. Richardson A Prospective Randomized Comparison of Patellar Tendon Versus Semitendinosus and Gracilis Tendon Autografts for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., March 1, 2002; 30(2): 214 - 220. [Abstract] [Full Text] [PDF]

				P. P. Provenzano, D. Heisey, K. Hayashi, R. Lakes, and R. Vanderby Jr. Subfailure damage in ligament: a structural and cellular evaluation J Appl Physiol, January 1, 2002; 92(1): 362 - 371. [Abstract] [Full Text] [PDF]

				A. K. Aune, I. Holm, M. A. Risberg, H. K. Jensen, and H. Steen Four-Strand Hamstring Tendon Autograft Compared with Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction: A Randomized Study with Two-Year Follow-Up Am. J. Sports Med., November 1, 2001; 29(6): 722 - 728. [Abstract] [Full Text] [PDF]

				M. Jassem, A. T. Rose, K. Meister, P. A. Indelicato, and D. Wheeler Biomechanical Analysis of the Effect of Varying Suture Pitch in Tendon Graft Fixation: Varying Suture Pitch in Tendon Graft Fixation Am. J. Sports Med., November 1, 2001; 29(6): 734 - 737. [Abstract] [Full Text] [PDF]

				A. J. Colosimo, R. S. Heidt Jr, J. A. Traub, and R. L. Carlonas Revision Anterior Cruciate Ligament Reconstruction with a Reharvested Ipsilateral Patellar Tendon Am. J. Sports Med., November 1, 2001; 29(6): 746 - 750. [Abstract] [Full Text] [PDF]

				J. B. Selby, D. L. Johnson, P. Hester, and D. N.M. Caborn Effect of Screw Length on Bioabsorbable Interference Screw Fixation in a Tibial Bone Tunnel Am. J. Sports Med., September 1, 2001; 29(5): 614 - 619. [Abstract] [Full Text] [PDF]

				F. R. Noyes and S. D. Barber-Westin Revision Anterior Cruciate Surgery with Use of Bone-Patellar Tendon-Bone Autogenous Grafts J. Bone Joint Surg. Am., August 1, 2001; 83(8): 1131 - 1143. [Abstract] [Full Text]

				P. Kousa, T. L.N. Jarvinen, P. Kannus, and M. Jarvinen Initial Fixation Strength of Bioabsorbable and Titanium Interference Screws in Anterior Cruciate Ligament Reconstruction: Biomechanical Evaluation by Single Cycle and Cyclic Loading Am. J. Sports Med., July 1, 2001; 29(4): 420 - 425. [Abstract] [Full Text] [PDF]

				E. Tsuda, Y. Okamura, Y. Ishibashi, H. Otsuka, and S. Toh Techniques for Reducing Anterior Knee Symptoms after Anterior Cruciate Ligament Reconstruction Using a Bone-Patellar Tendon-Bone Autograft Am. J. Sports Med., July 1, 2001; 29(4): 450 - 456. [Abstract] [Full Text] [PDF]

				Y. Ishibashi, S. Toh, Y. Okamura, T. Sasaki, and T. Kusumi Graft Incorporation within the Tibial Bone Tunnel after Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Autograft Am. J. Sports Med., July 1, 2001; 29(4): 473 - 479. [Abstract] [Full Text] [PDF]

				H. P. Jones, M. J. Lemos, and A. A. Schepsis Salvage of Failed Acromioclavicular Joint Reconstruction Using Autogenous Semitendinosus Tendon from the Knee: Surgical Technique and Case Report Am. J. Sports Med., March 1, 2001; 29(2): 234 - 237. [Full Text] [PDF]

				D. G. Nagarkatti, B. P. McKeon, B. S. Donahue, and J. P. Fulkerson Mechanical Evaluation of a Soft Tissue Interference Screw in Free Tendon Anterior Cruciate Ligament Graft Fixation Am. J. Sports Med., January 1, 2001; 29(1): 67 - 71. [Abstract] [Full Text] [PDF]

				S. L.-Y. Woo, T. M. Vogrin, and S. D. Abramowitch Healing and Repair of Ligament Injuries in the Knee J. Am. Acad. Ortho. Surg., November 1, 2000; 8(6): 364 - 372. [Abstract] [Full Text] [PDF]

				S. Nicklin, C. Waller, P. Walker, W. K. Chung, and W. R. Walsh In Vitro Structural Properties of Braided Tendon Grafts Am. J. Sports Med., November 1, 2000; 28(6): 790 - 793. [Abstract] [Full Text] [PDF]

				K. P. Black, M. M. Saunders, K. C. Stube, M. J.R. Moulton, and C. R. Jacobs Effects of Interference Fit Screw Length on Tibial Tunnel Fixation for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., November 1, 2000; 28(6): 846 - 849. [Abstract] [Full Text] [PDF]

				J. C. Brand Jr, D. Pienkowski, E. Steenlage, D. Hamilton, D. L. Johnson, and D. N.M. Caborn Interference Screw Fixation Strength of a Quadrupled Hamstring Tendon Graft Is Directly Related to Bone Mineral Density and Insertion Torque Am. J. Sports Med., September 1, 2000; 28(5): 705 - 710. [Abstract] [Full Text] [PDF]

				J. Brand Jr., A. Weiler, D. N. M. Caborn, C. H. Brown Jr., and D. L. Johnson Graft Fixation in Cruciate Ligament Reconstruction Am. J. Sports Med., September 1, 2000; 28(5): 761 - 774. [Abstract] [Full Text] [PDF]

				E. R. Aronowitz, T. J. Ganley, J. R. Goode, J. R. Gregg, and J. S. Meyer Anterior Cruciate Ligament Reconstruction In Adolescents With Open Physes Am. J. Sports Med., March 1, 2000; 28(2): 168 - 175. [Abstract] [Full Text] [PDF]

				M. Yamanaka, K. Yasuda, H. Tohyama, H. Nakano, and T. Wada The Effect of Cyclic Displacement On the Biomechanical Characteristics of Anterior Cruciate Ligament Reconstructions Am. J. Sports Med., November 1, 1999; 27(6): 772 - 777. [Abstract] [Full Text] [PDF]

D. M. Stadelmaier, W. R. Lowe, O. A. Ilahi, P. C. Noble, and H. W. Kohl III Cyclic Pull-Out Strength of Hamstring Tendon Graft Fixation with Soft Tissue Interference Screws: Influence of Screw Length Am. J. Sports Med., November 1, 1999; 27(6): 778 - 783. [Abstract] [Full Text] [PDF]