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• W3157232714 abstract "We thank the Editor for the opportunity to respond to the letter by Smith et al.1Smith P.A. DiFelice G.S. Duoguih W.A. Sonnery-Cottet B. Pace L.J. Regarding “suture tape augmentation has no effect on anterior tibial translation, gap formation, or load to failure of anterior cruciate ligament repair: A biomechanical pilot study.”.Arthroscopy. 2021; 37: 1372-1374Abstract Full Text Full Text PDF Scopus (1) Google Scholar regarding our recent article “Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study,” which appeared in Arthroscopy, Sports Medicine, and Rehabilitation.2Qin C. Kahn A. Amirouche F. et al.Suture tape augmentation has no effect on anterior tibial translation, gap formation, or load to failure of anterior cruciate ligament repair: A biomechanical pilot study.Arthrosc Sports Med Rehabil. 2021; 3: e233-e239Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Our biomechanical understanding of anterior cruciate ligament (ACL) repair has been tremendously advanced by leaders in the field, including the authors of the letter.3Bachmaier S. DiFelice G.S. Sonnery-Cottet B. et al.Treatment of acute proximal anterior cruciate ligament tears—part 2: The role of internal bracing on gap formation and stabilization of repair techniques.Orthop J Sports Med. 2020; 8 (2325967119897423)Google Scholar,4Smith P.A. Cook C.S. Knotless primary anterior cruciate ligament repair with adjustable loop device and internal brace augmentation.Arthrosc Tech. 2020; 9: e1967-e1975Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar We acknowledge our methodology does represent a deviation from the manufacturer’s currently promoted technique using the InternalBrace (IB) concept for ACL repair. At the time of our study conception in mid-2019, a consensus with regards to technique and fixation for ACL repair was not clear based on the available literature. At the time, we felt that the cortical anchor-based ACL repair would provide more reproducible tensioning ability compared with tying knots. As Smith et al.1Smith P.A. DiFelice G.S. Duoguih W.A. Sonnery-Cottet B. Pace L.J. Regarding “suture tape augmentation has no effect on anterior tibial translation, gap formation, or load to failure of anterior cruciate ligament repair: A biomechanical pilot study.”.Arthroscopy. 2021; 37: 1372-1374Abstract Full Text Full Text PDF Scopus (1) Google Scholar astutely mention in their letter, potential issues with our method of extracortical femoral fixation include suture-cutting effects around bony corners, particularly in cadaveric bone. The reader should be aware of the distinct possibility that our choice of femoral fixation may impact our ability to assess the effect of IB on ACL repair. Instead, what can be concluded from our findings is that the average load to failure seen in our study for both the IB and non-IB groups was similar to average loads reported in other studies.3Bachmaier S. DiFelice G.S. Sonnery-Cottet B. et al.Treatment of acute proximal anterior cruciate ligament tears—part 2: The role of internal bracing on gap formation and stabilization of repair techniques.Orthop J Sports Med. 2020; 8 (2325967119897423)Google Scholar,5Massey P. Parker D. McClary K. Robinson J. Barton R.S. Solitro G.F. Biomechanical comparison of anterior cruciate ligament repair with internal brace augmentation versus anterior cruciate ligament repair without augmentation.Clin Biomech (Bristol, Avon). 2020; 77: 105065Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Nonetheless, we echo the message that we conveyed in our manuscript and is stated in the letter: to exercise caution when generalizing the results of our or any biomechanical study to clinically relevant practice. We did report absolute differences in gap formation between the IB and non-IB groups that may be clinically meaningful but were not statistically significant. As disclosed in the discussion our manuscript, our findings are subject to type II error, which readers should account for when interpreting our pilot results. Moreover, gap formation was measured between predefined fixed points via a caliper and performed by a senior author who is an experienced biomechanical engineer and professor of orthopaedic research. Although we were meticulous in the technique we used for these measurements, we acknowledge other investigators’ work with larger sample sizes and a more refined method of data acquisition in advancing our biomechanical understanding of suture tape augmentation.3Bachmaier S. DiFelice G.S. Sonnery-Cottet B. et al.Treatment of acute proximal anterior cruciate ligament tears—part 2: The role of internal bracing on gap formation and stabilization of repair techniques.Orthop J Sports Med. 2020; 8 (2325967119897423)Google Scholar Despite these limitations, we believe there are valuable points that may be gleaned from our pilot study. ACL repair techniques continue to be refined and our study assesses a specific technique with a uniform mechanism of failure. In addition, we introduced a comparison of Krakow, Bunnell, and luggage tag suture configurations for capturing remnant ACL tissue, which showed superiority of the Krakow stitch. This serves as a foundation for further investigation into the optimal suture configuration to capture ACL tissue during repair, as there does not seem to be a clear consensus in the literature. We also detected high load to failure in ACL repair in both IB and non-IB groups, well over the minimum necessary for early range of motion. We believe that recent investigations into the effect of IB in ACL repair should be commended for the thoughtfulness of their testing protocols, data acquisition, and analysis.3Bachmaier S. DiFelice G.S. Sonnery-Cottet B. et al.Treatment of acute proximal anterior cruciate ligament tears—part 2: The role of internal bracing on gap formation and stabilization of repair techniques.Orthop J Sports Med. 2020; 8 (2325967119897423)Google Scholar,5Massey P. Parker D. McClary K. Robinson J. Barton R.S. Solitro G.F. Biomechanical comparison of anterior cruciate ligament repair with internal brace augmentation versus anterior cruciate ligament repair without augmentation.Clin Biomech (Bristol, Avon). 2020; 77: 105065Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar We are humbled to contribute to the scientific process on ACL research and embrace this opportunity to acknowledge and further clarify the limitations in our methodology. Download .pdf (9.11 MB) Help with pdf files ICMJE author disclosure forms" @default.
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• W3157232714 title "Author Reply to “Regarding ‘Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study’”" @default.
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