Original article
A biomechanical comparison of three lower extremity tendons for ligamentous reconstruction about the knee

https://doi.org/10.1016/j.arthro.2003.10.015Get rights and content

Abstract

Purpose: The purpose of this investigation was to evaluate 3 previously unreported allograft tendons for use in knee surgery. These are the doubled tibialis anterior (TA), doubled tibialis posterior (TP), and doubled peroneus longus (PL) tendons. Type of Study: A biomechanical evaluation of the properties of the TA, TP, and PL. Methods: Sixteen fresh-frozen cadaveric lower limbs were used for testing. All specimens had the TA, TP, and PL tendons harvested. All specimens were tested in a custom-designed hydraulic testing machine using dry ice clamps. Each tendon was elongated at a rate of 1 mm/s. Load and displacement were recorded with an analog to digital interface board. Stiffness, modulus of elasticity, and stress and strain at failure were calculated. Results: The average tested lengths of the TA, TP, and PL were 37 cm (range, 13–68 cm), 33 cm (range, 7–74 cm), and 42 cm (range, 17–69 cm), respectively. The average cross-sectional areas of the doubled TA, TP, and PL were 38 mm2, 48 mm2, and 37 mm2, respectively. The average failure loads for the doubled TA, TP, and PL tendons were 3,412 N, 3,391 N, and 2,483 N, respectively. The maximum stresses of the 3 tendons did not differ significantly (85–108 Mpa). The TA had the greatest stiffness (344 N/mm), followed by the TP (302 N/mm) and the PL (244 N/mm). Previous authors have documented the biomechanical strength of grafts for ACL reconstruction between 1,700 and 2,900 Newtons. The ultimate tensile strength and stiffness reported for the TA and TP grafts exceeded that for all previously reported grafts, including the doubled semitendinosus-gracilis. Conclusions: The TA, TP, and PL tendons showed excellent biomechanical properties when compared with historical data evaluating other graft sources. The biomechanical properties observed for the TA, TP, and PL were noted in specimens despite an average age of 78.3 years.

Section snippets

Methods

Sixteen fresh-frozen cadaveric lower limbs were obtained from the University Anatomical Gifts Program. The average age of the tested specimens was 78.3 years (range, 66–89 years). Specimens were frozen at −20°C and thawed at room temperature the day of harvest. All specimens had the TA, TP, and PL tendons harvested from the musculotendinous junction to its insertion. All specimens were inspected for tendonitis, and any tendon that showed evidence of such was discarded. Each tendon was labeled

Results

For purposes of the study, tendons tested were placed into 1 of 3 groups: group 1: TA; group 2: TP; and group 3: PL. The average lengths of the TA, TP, and PL tendons were 37 cm (SE, ± 4.0), 33 cm (SE, ± 4.3), and 42 cm (SE, ± 3.4), respectively. The average cross-sectional areas of the doubled TA, doubled TP, and doubled PL tendons were 38 mm2, 48 mm2, and 37 mm2, respectively. No statistical difference was seen among the groups (P < .23) (Fig 2). No significant difference was seen in the

Discussion

Over the past 15 years, the patellar ligament has been frequently used as a graft source for reconstruction of the ACL. The popularity of this graft stems primarily from its high initial strength, potential for bone-to-bone healing, and the predictable success in achieving knee stability.4, 5, 9, 10, 11, 26 However, the morbidity associated with the use of the patellar ligament has been well described. Problems encountered have included donor site morbidity, patellofemoral pain, quadriceps

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    This Research was supported in part by Research Technology, Incorporated, Alachua, Florida.

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