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This Article Full Text Full Text (PDF) All Versions of this Article: 36/1/142    most recent 0363546507307393v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via Google Scholar Google Scholar Articles by DeBerardino, T. M. Articles by Brooks, D. E. Search for Related Content PubMed PubMed Citation Articles by DeBerardino, T. M. Articles by Brooks, D. E. Related Collections Achilles tendon Knee Graft fixation

Comparison of the Split Stacked Versus the Split Achilles Allograft for Dual Femoral Tunnel Posterior Cruciate Ligament Reconstruction

Thomas M. DeBerardino, MD^,*, Keith T. Lonergan, MD and Daniel E. Brooks

From Keller Army Community Hospital, West Point, New York, Eisenhower Army Medical Center, Augusta, Georgia, and US Army Institute of Surgical Research, Ft Sam Houston, Texas

^* Address correspondence to COL Thomas M. DeBerardino, MD, Keller Army Community Hospital, 900 Washington Rd, West Point, NY 10996 (e-mail: thomas.deberardino{at}na.amedd.army.mil).

Background: Cadaveric testing has shown that double-bundle reconstruction better replicates the native anatomy of the posterior cruciate ligament. With the current trend toward allograft Achilles posterior cruciate ligament reconstructions, the need to determine a graft configuration with the highest tensile and pull-out strength has become paramount.

Hypothesis: The split stacked Achilles allograft construct provides greater graft material to traverse the notch and provides increased load to failure at the tibial point of fixation compared with a standard monoblock Achilles allograft construct.

Study Design: Controlled laboratory study.

Methods: Eight matched pairs of Achilles allograft tendons were secured to 8 matched pairs of fresh-frozen human cadaveric tibiae. Group 1 consisted of single-block grafts (n = 8), and group 2 included the split stacked grafts (n = 8). The cross-sectional area of each graft’s 2 collagenous bundles was measured with a micrometer. The graft constructs were pulled to ultimate failure at a rate of 50 mm/min on a materials testing machine.

Results: The mean cross-sectional area of the group 2 split stacked grafts (76.6 ± 3.1 mm²) was significantly greater than that of the group 1 single-block grafts (48.2 ± 3.0 mm²; P =.00006). The maximum load to failure of the group 2 construct was significantly greater (1383 ± 102 N) than that of the group 1 single-block configuration (1020 ± 136 N; P =.01).

Conclusion: These results indicate that the novel split stacked configuration of an Achilles tendon allograft provides a greater cross-sectional area of graft material across the joint as well as a significant increase in the overall load to failure strength compared with a standard monoblock Achilles allograft construct.

Clinical Relevance: The split stacked Achilles graft is an efficient method for using the entire allograft. With maintenance and use of all collagen fibers, the split stacked Achilles construct provides essentially 2 grafts in 1 while only using a single tibial tunnel.

Key Words: posterior cruciate ligament (PCL) • Achilles allograft • split stacked Achilles • dual femoral tunnel