Reconstruction of the anterior cruciate ligament: dynamic strain evaluation of the graft

The study is focused on the biomechanical aspects of the anterior cruciate ligament (ACL) reconstruction procedures with an emphasis on evaluating the dynamic strain of materials commonly used for this purpose. Separate and multiple, equally tensioned strands of hamstring grafts used for the reconstruction of the ACL were biomechanically tested and compared to original ACL and bone-patellar tendon-bone (BPTB) grafts, using tissue samples from cadavers. The study was focused on measuring such material properties as the strength, stiffness, maximum load, and elongation at maximum load of the original ACL, BPTB graft, and single tendon hamstring (gracilis and semitendinosus) grafts, continued by double strands and finally by four-strand graft (STG) evaluation. Fresh-frozen cadaveric knees were used, which had been clamped and tensioned equally. The measurement was performed by drop-weight testing, using a Laser Doppler Vibrometer as a basic sensor of the dynamic movements of the gripping clamps, with parallel correlation by a piezoelectric transducer. The grafts for experiments were obtained from 21-paired knees. The measurement was performed at room temperature (21°C) after 24 h of thawing at 4°C. All the specimens were measured for their response to the dynamic tensile load. The maximum strength values were obtained and calculated for the appropriate section area of the specimen. The tensioned strands of the original ACL showed a maximum average load of 1,246 ± 243 N in the section area of about 30 mm² (max. stress 41.3 MPa); the strands of BPTB grafts showed values of 3,855 ± 550 N in the section area of 80 mm² (max. stress 40.6 MPa); the gracilis tendons showed 925 ± 127 N in the section area of 10 mm² (max. stress 95.1 MPa) and the semitendinosuss yielded a result of 2,050 ± 159 N in the area of 20 mm² (max. stress 88.7 MPa). Of all the materials, the original ACL have the lowest strength and stiffness in respect of their biomechanical properties. BPTB grafts showed a slightly higher value of maximum stress, while both the gracilis and semitendinosus tendons showed double the value of maximum load per section area—tensile stress. Two- and four- combined hamstring strands clamped together and equally tensioned with a drop-weight had the combined tensile strength properties of the individual strands within the estimated range of measurement errors. No significant changes in maximum loads/stresses were observed under impact loading conditions. The results of this study demonstrate that equally tensioned four-strand hamstring-tendon grafts have higher initial tensile properties than those in other varieties of samples. From a biomechanical point of view, they seem to be a reasonable alternative procedure for ACL reconstruction.