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Biomechanics of hamstring tendon, quadriceps tendon, and bone–patellar tendon–bone grafts for anterior cruciate ligament reconstruction: a cadaveric study

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Abstract

Purpose

The three most commonly used autografts for anterior cruciate ligament reconstruction (ACL) are: bone–patellar tendon–bone (BTB), hamstring tendons (HT), and quadriceps tendon (QT). A cadaveric study was performed to determine if there were any differences in mechanical and structural properties under biomechanical testing.

Methods

Twenty-seven graft specimens were harvested from 9 human cadaveric legs. Mean donor age was 75.2 years (range 53–85 years). Twenty-two specimens (8 HT, 7 QT, and 7 BTB) completed cyclic preconditioning from 50 to 800 N for 200 cycles and a load to failure test at an extension rate of 1 mm/s. Structural and mechanical properties of BTB, HT, and QT grafts were compared using a one-way ANOVA and Tukey’s honest significant difference.

Results

There was no difference in the ultimate load to failure (N) across all 3 graft types (p = 0.951). Quadriceps tendon demonstrated greater cross-sectional area (mm2) when compared to both HT and BTB (p = 0.001) and was significantly stiffer (N/mm) than HT but not BTB (p = 0.004). Stress (N/mm2) of the HT at ultimate load was greater than QT but not BTB (p = 0.036). Elastic modulus (MPa) of HT was greater than both QT and BTB (p = 0.016).

Conclusion

There was no difference in the ultimate load to failure of BTB, HT, and QT grafts harvested from the same specimens. All 3 grafts had similar loads to failure with a significant increase in stiffness when compared to the native ACL. Furthermore, QT demonstrated more favourable structural properties compared to HT and BTB with greater cross-sectional area to both HT and BTB and greater stiffness compared to HT.

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Data availability

Data and materials are available upon request.

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Acknowledgements

The authors would like to acknowledge the Orthopaedic Innovation Centre in Winnipeg, Manitoba, Canada, for their assistance with mechanical testing and clamp design and fabrication in this study.

Funding

This study was funded by the University of Manitoba Alexander Gibson Fund and the Pan Am Clinic Foundation. The institution of authors DH, SM, and PM has received general funds for research and education from Arthrex, CONMED Linvatec, and Zimmer Biomet.

Author information

Authors and Affiliations

  1. Pan Am Clinic Foundation, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada

    Darren Hart, Jeff Leiter & Sheila McRae

  2. Department of Surgery, University of Saskatchewan, Regina, SK, S4T2E5, Canada

    Tanner Gurney-Dunlop

  3. Department of Surgery, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada

    Jeff Leiter, Robert Longstaffe, Sheila McRae & Peter MacDonald

  4. Pan Am Clinic, Winnipeg, MB, R3M 3E4, Canada

    Robert Longstaffe & Peter MacDonald

  5. University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, LA9 7RG, UK

    Ahmed Shawky Eid

Authors
  1. Darren Hart
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  7. Peter MacDonald
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Contributions

All authors contributed substantially to the project. DH, TG-D, JL, and PM designed the study. DH conducted the data acquisition. DH and SM participated in the analysis of the data. DH, TG-D, JL, RL, ASE, SM, and PM conducted the data interpretation. DH, TG-D, JL, RL, ASE, SM, and PM drafted and reviewed the manuscript. All of the authors approved the content of the manuscript before the submission.

Corresponding author

Correspondence to Darren Hart.

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Conflict of interest

The authors have no competing interests to declare that are relevant to the content of this article.

Ethical Approval

Ethical approval for this study was obtained from the University of Manitoba Research Ethics and Compliance Health Research Ethics Board. Ethics# HS24041(H2020:301).

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Hart, D., Gurney-Dunlop, T., Leiter, J. et al. Biomechanics of hamstring tendon, quadriceps tendon, and bone–patellar tendon–bone grafts for anterior cruciate ligament reconstruction: a cadaveric study. Eur J Orthop Surg Traumatol 33, 1067–1074 (2023). https://doi.org/10.1007/s00590-022-03247-6

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  • DOI: https://doi.org/10.1007/s00590-022-03247-6

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