Download PDF
J Knee Surg 2023; 36(12): 1224-1229
DOI: 10.1055/s-0042-1755374
Original Article

Effect of Poly-L-Lactic Acid Mesh Augmentation on Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

Heath P. Gould
1   Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
,
William R. Rate IV
2   Georgetown University School of Medicine, Washington, District of Columbia
,
Ryan A. Harrell
1   Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
,
Pooyan Abbasi
1   Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
,
Allison L. Fillar 
1   Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

No previous study has investigated poly-L-lactic acid (PLLA) surgical mesh augmentation in the repair of inferior pole patellar tendon rupture. We compared the biomechanical properties of transosseous patellar tendon repair with PLLA surgical mesh augmentation to transosseous repair without augmentation. Ten matched pairs of cadaveric knees were used. Specimens in each pair were randomized to undergo the transosseous technique alone or the transosseous technique augmented with a PLLA surgical mesh. An inferior pole patellar tendon rupture was simulated and the repair procedure was performed. Specimens were cyclically loaded for 500 cycles. Gap formation was measured using two sensors placed medial and lateral to the repair site. After cyclic loading, load to failure was determined by pulling the tendon at a constant rate until a sudden decrease in load occurred. The primary outcome measure was cyclic gap formation at the medial and lateral sensors. Compared with controls, specimens that underwent PLLA mesh-augmented repair had significantly lower medial gap formation at all testing intervals up to 500 cycles (p < 0.05) and significantly lower lateral gap formation at all testing intervals from 10 to 500 cycles (p < 0.05). Transosseous patellar tendon repair augmented with a PLLA woven mesh device provided significantly greater resistance to gap formation compared with transosseous repair alone. These results suggest that PLLA mesh augmentation of the transosseous technique is biomechanically effective for patellar tendon repair.

Keywords

patellar - tendon - poly-L-lactic acid - mesh - cadaveric - biomechanics

Note

Synthasome, Inc. donated hardware for this study; Arthrex, Inc. donated hardware for this study; all authors have no disclosures to report.




Publication History

Received: 22 June 2021

Accepted: 19 June 2022

Article published online:
01 September 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ong BC, Sherman O. Acute patellar tendon rupture: a new surgical technique. Arthroscopy 2000; 16 (08) 869-870
    CrossrefPubMedGoogle Scholar
  • 2 Bouget P, Breque C, Beranger JS, Faure JP, Khiami F, Vendeuvre T. Biomechanical cadaveric comparison of patellar ligament suture protected by a steel cable versus a synthetic cable. J Exp Orthop 2017; 4 (01) 9
    CrossrefPubMedGoogle Scholar
  • 3 Black JC, Ricci WM, Gardner MJ. et al. Novel augmentation technique for patellar tendon repair improves strength and decreases gap formation: a cadaveric study. Clin Orthop Relat Res 2016; 474 (12) 2611-2618
    CrossrefPubMedGoogle Scholar
  • 4 Rothfeld A, Pawlak A, Liebler SAH, Morris M, Paci JM. Patellar tendon repair augmentation with a knotless suture anchor internal brace: a biomechanical cadaveric study. Am J Sports Med 2018; 46 (05) 1199-1204
    CrossrefPubMedGoogle Scholar
  • 5 Meyer Z, Ricci WM. Knee extensor mechanism repairs: standard suture repair and novel augmentation technique. J Orthop Trauma 2016; 30 (Suppl. 02) S30-S31
    CrossrefPubMedGoogle Scholar
  • 6 Gould HP, Weiner DA, Tomaszewski PM, Parks BG, Abbasi P, Fillar AL. High-strength suture tape augmentation improves cyclic gap formation in transosseous patellar tendon repair: a biomechanical study. Arthrosc Sports Med Rehabil 2020; 2 (05) e469-e473
    CrossrefPubMedGoogle Scholar
  • 7 Mihalko WM, Vance M, Fineberg MJ. Patellar tendon repair with hamstring autograft: a cadaveric analysis. Clin Biomech (Bristol, Avon) 2010; 25 (04) 348-351
    CrossrefPubMedGoogle Scholar
  • 8 Van der Bracht H, Verdonk R, Stuyts B. Augmentation of a patellar tendon repair with an autologous semitendinosus graft. Acta Orthop Belg 2009; 75 (03) 417-419
    PubMedGoogle Scholar
  • 9 Wuller TG, Jansson KA, Bruner BW. Augmentation of the patellar ligament with a bone-patellar tendon-bone inlay allograft. Arthroscopy 1998; 14 (01) 89-93
    CrossrefPubMedGoogle Scholar
  • 10 Woodmass JM, Johnson JD, Wu IT, Krych AJ, Stuart MJ. Patellar tendon repair with ipsilateral semitendinosus autograft augmentation. Arthrosc Tech 2017; 6 (06) e2177-e2181
    CrossrefPubMedGoogle Scholar
  • 11 Espregueira-Mendes J, Andrade R, Michael MJSF. et al. Augmentation of patellar tendon repair with autologous semitendinosus Graft-Porto technique. Arthrosc Tech 2017; 6 (06) e2271-e2276
    CrossrefPubMedGoogle Scholar
  • 12 Merloz P, Minfelde R, Schelp C. et al. In vitro study of the properties of bioresorbable lactic acid polymer materials [in French]. Rev Chir Orthop Reparatrice Appar Mot 1995; 81 (05) 433-444
    PubMedGoogle Scholar
  • 13 Athanasiou KA, Niederauer GG, Agrawal CM. Sterilization, toxicity, biocompatibility and clinical applications of polylactic acid/polyglycolic acid copolymers. Biomaterials 1996; 17 (02) 93-102
    CrossrefPubMedGoogle Scholar
  • 14 Yoon SD, Kwon YS, Lee KS. Biodegradation and biocompatibility of poly l–lactic acid implantable mesh. Int Neurourol J 2017; 21 (Suppl. 01) S48-S54
    CrossrefPubMedGoogle Scholar
  • 15 Derwin KA, Codsi MJ, Milks RA, Baker AR, McCarron JA, Iannotti JP. Rotator cuff repair augmentation in a canine model with use of a woven poly-L-lactide device. J Bone Joint Surg Am 2009; 91 (05) 1159-1171
    CrossrefPubMedGoogle Scholar
  • 16 Smith RDJ, Zargar N, Brown CP. et al. Characterizing the macro and micro mechanical properties of scaffolds for rotator cuff repair. J Shoulder Elbow Surg 2017; 26 (11) 2038-2046
    CrossrefPubMedGoogle Scholar
  • 17 Smith RD, Carr A, Dakin SG, Snelling SJ, Yapp C, Hakimi O. The response of tenocytes to commercial scaffolds used for rotator cuff repair. Eur Cell Mater 2016; 31: 107-118
    CrossrefPubMedGoogle Scholar
  • 18 McCarron JA, Milks RA, Chen X, Iannotti JP, Derwin KA. Improved time-zero biomechanical properties using poly-L-lactic acid graft augmentation in a cadaveric rotator cuff repair model. J Shoulder Elbow Surg 2010; 19 (05) 688-696
    CrossrefPubMedGoogle Scholar
  • 19 Proctor CS. Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device. J Shoulder Elbow Surg 2014; 23 (10) 1508-1513
    CrossrefPubMedGoogle Scholar
  • 20 Inui A, Kokubu T, Fujioka H. et al. Application of layered poly (L-lactic acid) cell free scaffold in a rabbit rotator cuff defect model. Sports Med Arthrosc Rehabil Ther Technol 2011; 3: 29
    CrossrefPubMedGoogle Scholar
  • 21 Lenart BA, Martens KA, Kearns KA, Gillespie RJ, Zoga AC, Williams GR. Treatment of massive and recurrent rotator cuff tears augmented with a poly-l-lactide graft, a preliminary study. J Shoulder Elbow Surg 2015; 24 (06) 915-921
    CrossrefPubMedGoogle Scholar
  • 22 Krushinski EM, Parks BG, Hinton RY. Gap formation in transpatellar patellar tendon repair: pretensioning Krackow sutures versus standard repair in a cadaver model. Am J Sports Med 2010; 38 (01) 171-175
    CrossrefPubMedGoogle Scholar
  • 23 Ravalin RV, Mazzocca AD, Grady-Benson JC, Nissen CW, Adams DJ. Biomechanical comparison of patellar tendon repairs in a cadaver model: an evaluation of gap formation at the repair site with cyclic loading. Am J Sports Med 2002; 30 (04) 469-473
    CrossrefPubMedGoogle Scholar
  • 24 Marder RA, Timmerman LA. Primary repair of patellar tendon rupture without augmentation. Am J Sports Med 1999; 27 (03) 304-307
    CrossrefPubMedGoogle Scholar
  • 25 Janssen RP, Scheffler SU. Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2014; 22 (09) 2102-2108
    CrossrefPubMedGoogle Scholar
  • 26 Lindy PB, Boynton MD, Fadale PD. Repair of patellar tendon disruptions without hardware. J Orthop Trauma 1995; 9 (03) 238-243
    CrossrefPubMedGoogle Scholar
  • 27 Ratcliffe A, Butler DL, Dyment NA. et al. Scaffolds for tendon and ligament repair and regeneration. Ann Biomed Eng 2015; 43 (03) 819-831
    CrossrefPubMedGoogle Scholar
  • 28 Massey PA, Myers M, McClary K, Brown J, Barton RS, Solitro GF. Biomechanical analysis of patellar tendon repair with knotless suture anchor tape versus transosseous suture. Orthop J Sports Med 2020; 8 (10) 2325967120954808
    CrossrefPubMedGoogle Scholar
  • 29 Almazán A, Miguel A, Odor A, Ibarra JC. Intraoperative incidents and complications in primary arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 2006; 22 (11) 1211-1217
    CrossrefPubMedGoogle Scholar