High-load preconditioning of human soft tissue hamstring grafts: An in vitro biomechanical analysis View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2016-09-13

AUTHORS

W. Charles Lockwood, Daniel Cole Marchetti, Kimi D. Dahl, Jacob D. Mikula, Brady T. Williams, Matthew M. Kheir, Travis Lee Turnbull, Robert F. LaPrade

ABSTRACT

PurposeIn order to minimize viscoelastic elongation of ACL reconstruction grafts, preconditioning protocols have been employed in clinical practice prior to final graft fixation. The purpose of this study was to evaluate two separate high-load static preconditioning protocols of double-looped semitendinosus–gracilis grafts and compare these results to both a current clinical protocol and a control group with no preconditioning protocol applied. It was hypothesized that a high-load, static preconditioning protocol would minimize graft elongation during a simulated progressive early rehabilitation compared to both the “89 N” clinical protocol and control groups.MethodsGrafts were randomly allocated into four preconditioning study groups: (1) control (no preconditioning), (2) clinical protocol (89 N for 15 min), (3) high-load, short duration (600 N for 20 s), and (4) high-load, long duration (600 N for 15 min). After preconditioning, grafts were cyclically loaded between 10 and 400 N at 0.5 Hz for 450 cycles to simulate early postoperative rehabilitation. Graft displacement (elongation) was recorded during both preconditioning and cyclic loading.ResultsIncreased preconditioning load magnitude and duration significantly reduced graft elongation during cyclic loading (p < 0.05) which corresponded to an inverse relationship with increased elongation during preconditioning. The “600 N for 15 min” protocol resulted in significantly less elongation during simulated early rehabilitation than both the control group and the “89 N for 15 min” protocol (p < 0.001, p < 0.05).ConclusionsGraft elongation during simulated early rehabilitation was significantly reduced by a high-load preconditioning protocol applied for an extended period of time compared to a current common clinical protocol and grafts that were not preconditioned. In addition, the amount of elongation during simulated early rehabilitation was similar between grafts preconditioned using the current clinical practice protocol and the high-load/short-duration protocol, implying that the latter could potentially induce the same viscoelastic changes in soft tissue grafts as the current clinical practice. The “600 N for 20 s” preconditioning protocol may provide similar postoperative results as the clinical protocol, “89 N for 15 min”, and also reduce or maintain operative time. A high-load preconditioning protocol that reduces graft elongation may benefit patients undergoing ACL reconstruction, especially for cases of failed primary reconstruction, genu recurvatum, and increased tibial slope, where maintaining graft length is imperative to restore knee stability. More... »

PAGES

138-143

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00167-016-4317-5

DOI

http://dx.doi.org/10.1007/s00167-016-4317-5

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1005323602

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27624178


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30 schema:description PurposeIn order to minimize viscoelastic elongation of ACL reconstruction grafts, preconditioning protocols have been employed in clinical practice prior to final graft fixation. The purpose of this study was to evaluate two separate high-load static preconditioning protocols of double-looped semitendinosus–gracilis grafts and compare these results to both a current clinical protocol and a control group with no preconditioning protocol applied. It was hypothesized that a high-load, static preconditioning protocol would minimize graft elongation during a simulated progressive early rehabilitation compared to both the “89 N” clinical protocol and control groups.MethodsGrafts were randomly allocated into four preconditioning study groups: (1) control (no preconditioning), (2) clinical protocol (89 N for 15 min), (3) high-load, short duration (600 N for 20 s), and (4) high-load, long duration (600 N for 15 min). After preconditioning, grafts were cyclically loaded between 10 and 400 N at 0.5 Hz for 450 cycles to simulate early postoperative rehabilitation. Graft displacement (elongation) was recorded during both preconditioning and cyclic loading.ResultsIncreased preconditioning load magnitude and duration significantly reduced graft elongation during cyclic loading (p < 0.05) which corresponded to an inverse relationship with increased elongation during preconditioning. The “600 N for 15 min” protocol resulted in significantly less elongation during simulated early rehabilitation than both the control group and the “89 N for 15 min” protocol (p < 0.001, p < 0.05).ConclusionsGraft elongation during simulated early rehabilitation was significantly reduced by a high-load preconditioning protocol applied for an extended period of time compared to a current common clinical protocol and grafts that were not preconditioned. In addition, the amount of elongation during simulated early rehabilitation was similar between grafts preconditioned using the current clinical practice protocol and the high-load/short-duration protocol, implying that the latter could potentially induce the same viscoelastic changes in soft tissue grafts as the current clinical practice. The “600 N for 20 s” preconditioning protocol may provide similar postoperative results as the clinical protocol, “89 N for 15 min”, and also reduce or maintain operative time. A high-load preconditioning protocol that reduces graft elongation may benefit patients undergoing ACL reconstruction, especially for cases of failed primary reconstruction, genu recurvatum, and increased tibial slope, where maintaining graft length is imperative to restore knee stability.
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37 schema:keywords ACL reconstruction
38 ACL reconstruction graft
39 ConclusionsGraft elongation
40 High-load preconditioning
41 Hz
42 MethodsGrafts
43 addition
44 amount
45 amount of elongation
46 analysis
47 biomechanical analysis
48 cases
49 changes
50 clinical practice
51 clinical practice protocols
52 clinical protocols
53 common clinical protocol
54 control
55 control group
56 current clinical practice
57 current clinical practice protocol
58 current clinical protocols
59 current common clinical protocol
60 cycle
61 cyclic loading
62 displacement
63 duration
64 early postoperative rehabilitation
65 early rehabilitation
66 elongation
67 extended period
68 final graft fixation
69 fixation
70 genu recurvatum
71 graft
72 graft displacement
73 graft elongation
74 graft fixation
75 graft length
76 group
77 high-load preconditioning protocol
78 high-load static preconditioning protocols
79 human soft tissue
80 inverse relationship
81 knee stability
82 length
83 less elongation
84 load magnitude
85 loading
86 longer duration
87 magnitude
88 min
89 operative time
90 order
91 patients
92 period
93 postoperative rehabilitation
94 postoperative results
95 practice
96 practice protocols
97 preconditioning
98 preconditioning protocol
99 primary reconstruction
100 progressive early rehabilitation
101 protocol
102 purpose
103 purposeIn order
104 reconstruction
105 reconstruction graft
106 recurvatum
107 rehabilitation
108 relationship
109 results
110 same viscoelastic changes
111 semitendinosus-gracilis graft
112 separate high-load static preconditioning protocols
113 short duration
114 short-duration protocol
115 similar postoperative results
116 slope
117 soft tissue
118 soft tissue grafts
119 stability
120 static preconditioning protocols
121 study
122 study group
123 tibial slope
124 time
125 tissue
126 tissue graft
127 viscoelastic changes
128 viscoelastic elongation
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