Suture tape augmentation technique
SwiveLock, knee
Patients randomised to the SA arm will use the Tightrope 2 femoral cortical button, which has a single strand of Fibertape looped through the proximal Tightrope to be run alongside the graft to serve as an augment. The femoral button and graft will then be docked into the femoral tunnel, 5 mm short of the tunnel depth by shortening the adjustable loop in a similar fashion to the standard ACL reconstruction group. The tibial side of the graft is then cycled 15 times with maximal manual tension applied. Secondary tibial fixation of the suture tape will be performed before the tibial graft, with a 4.75-mm SwiveLock anchor in full extension. A guide pin was drilled 1.5 cm distal to the tibial tunnel to a depth of 20mm and overrreamed with a 3.4-mm diameter reamer and 4.75-mm tap. Ensuring the free ends of the Fibertape are separate from the tibial-sided graft sutures, a haemostat is then placed underneath the FiberTape limbs to ensure it is not tighter than the graft. The suture tape is then fixed with a 4.75-mm SwiveLock anchor with the knee in maximal knee extension. The graft will be tensioned at 0° of knee flexion with a proprietary “fish scale” tensioning device used to apply tension to the graft at 80N, and a posterior force on the tibia. The tibial side of the graft will then be secured with an interference screw (PEEK; Arthrex Inc.), with the suture tape running alongside the graft through the tibial tunnel, with tension on the graft only. The knee is then cycled through a range of motion to ensure the full range is present. In order to ensure greater tension on the graft than the tape, the femoral side of the graft is then re-tensioned to ensure fully docked within the femoral tunnel at 30° of knee flexion.