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Different Suture Fixation Techniques for Posterior Cruciate
Ligament Avulsion Fractures: A Comparative Biomechanical
Study in Cadaveric Knees
Sorawut Thamyongkit1
, Pasit Komonsuwan1, Nadhaporn Saengpetch1*, Panya Aroonjarattham2
1 Faculty of Medicine, Ramathibodi Hospital, Mahidol University
2 Department of Mechanical Engineering, Faculty of Engineering, Mahidol University
*Corresponding Author E-mail: nadhaporn.sae@mahidol.ac.th
Background: Abstract
Posterior cruciate ligament avulsion fractures compromise knee stability and require
fixation. While screw fixation is standard, suture-based techniques offer a minimally
invasive alternative. This study investigates the biomechanical properties of different
suture fixation techniques compared to traditional antegrade screw fixation, assessing the
stability and impact of suture number and tunnel configuration.
Methods: Twenty human cadaveric knees were randomly divided into four groups: Group A
(antegrade screw fixation), Group B (suture fixation with 1 FiberTape and 2 tunnels), Group
C (suture fixation with 2 FiberTapes and 2 tunnels), and Group D (suture fixation with 2
FiberTapes and 3 tunnels). Biomechanical testing included cyclic loading (500 cycles, 10-
100 N) and load-to-failure tests. Measurements included elongation, stiffness, yield load,
maximum load, and failure modes. Bone mineral density was measured for all specimens.
Results: No significant differences in biomechanical properties were observed between groups (p >
0.05). The mean elongation values were 10.6 ± 3.4 mm (Group A), 10.1 ± 2.9 mm (Group
B), 13.9 ± 3.9 mm (Group C), and 21.9 ± 15.9 mm (Group D). The mean yield loads were
404.2 ± 86.4 N (Group A), 428.6 ± 197.6 N (Group B), 375.6 ± 110.9 N (Group C), and 393.5
± 140.2 N (Group D). Fragment breakage was the predominant failure mode in Groups
A and D, while suture cut-through was more common in Groups B and C. A significant
positive correlation was identified between BMD and yield load (r = 0.5108, p = 0.0214).
Conclusion: Suture fixation techniques demonstrated comparable biomechanical performance to
traditional screw fixation for PCL avulsion fractures. Increasing suture tapes or tunnels
did not improve load-to-failure resistance. These results underscore the importance of
considering bone quality when evaluating fixation strength and determining postoperative
rehabilitation protocols.
Harmony in health: Innovation for Sustainable Medicine
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