Promising Outcomes of Suture Tape Augmentation in Quadriceps Tendon Autograft Anterior Cruciate Ligament Reconstruction

The management of anterior cruciate ligament (ACL) injuries continually evolves with new interest in all-sort tissue quadriceps tendon autograft, and new interest in suture tape augmentation of the graft, particularly in high-risk patients with young age; female sex; lower limb alignment, tibial, or femoral abnormalities; hyperlaxity; concomitant meniscal and/or additional ligamentous injuries; or participation in high-risk sports. Load sharing suture tape enhances biomechanical stability of the reconstructed ACL, especially during the initial ingrowth and ligamentization phase, and biomechanical evidence highlights reduced risk of graft elongation and failure under the loads encountered during daily physical activities and sport. Optimal tape tensioning could be in knee hyperextension, when the ACL is at maximal length, to avoid overconstraint. Two-year published outcomes of this technique are excellent. Current comparative studies, however, have not shown superiority. Additional controlled studies, and studies with longer term follow-up are needed, as well as comparison to extra-articular tenodesis augmentation.