Poster 60. Biomechanical Analysis of Staple Versus Suture Anchor Fixation for Modified Lemaire Lateral Extra-articular Tenodesis
Year: 2026
Type: article
Abstract: Objective: Residual anterolateral rotatory instability (ALRI) after anterior cruciate ligament reconstruction (ACLR) can be devastating for patients and lead to graft failure. Lateral extra-articular tenodesis (LET) has been shown to help control ALRI in certain high-risk cases. Multiple methods of fixation of the LET graft have been utilized with no prior study demonstrating clear superiority. Currently the most common method of fixation is a 10-mm wide Richard's staple, though there is risk for ACL femoral tunnel penetration. The objective of the study was to perform a biomechanical analysis comparing both load to failure and pivot shift of modified Lemaire LET fixation with concomitant bone-patellar tendon-bone (BTB) ACLR between a knotless suture anchor and staple fixation. We hypothesized that suture anchors would be non-inferior to staple fixation in terms of both load to failure and residual pivot shift in the setting of BTB ACLR. Methods: 11 matched pairs of fresh-frozen cadaveric knees with a mean age of 56.7 were obtained through a regional tissue bank. Specimens were randomized by a computer system to receive either suture anchor or staple fixation. Pivot shift was measured with native ACL, cut ACL, after ACLR, and after ACLR and LET (ACLR+LET) at 0, 30, and 60 degrees using a servohydraulic mechanical testing system (MTS) system. Load to failure testing was performed by releasing the IT band from Gerdy's tubercle and affixing to the MTS. The graft was then tensioned at a rate of 2mm/second until failure. Force at time of failure and location of failure were both recorded. Results: After LET fixation, mean pivot shift translation at 0 degrees of knee flexion (mean 21.14±10.63 for suture anchor, mean 28.06 mm± 7.83 for staple fixation, p=0.098), 30 degrees (10.93 mm±5.12, 12.07 mm±4.16, p=0.57), and 60 degrees (2.57 mm±1.68, 2.48±1.48, p=0.90) did not differ significantly between suture anchor and staple fixation, respectively. Average load to failure was significantly higher with suture anchor was 156.9N (±26.4) versus 115.5N (±32.5) with staple fixation (p<0.05). The tendon-suture or tendon-staple interface was the most common location of failure in both groups. Conclusions: This biomechanical study found that suture anchor fixation for LET is non-inferior to staple fixation in restoring pivot shift stability and is significantly more resistant to mechanical failure than staple fixation. With the risk of tunnel penetration when using staples, suture anchors are a viable alternative for LET graft fixation.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W7204841894