Editorial Commentary: The Suture-Augmented Anterior Cruciate Ligament Reconstruction Requires Independent Tensioning to Achieve Load Sharing

Countless variations of anterior cruciate ligament repair or reconstruction plus augmentation have existed for decades, but augmentation was associated with complications such as reactive synovitis, instability, loosening, and rupture. Recently, augmentation with ultra-high molecular weight polyethylene suture or suture tape, however, has not been shown to be associated with these complications. The goal when performing suture augmentation is to provide independent tensioning of the suture augment and graft to allow the suture or suture tape to function as a load-sharing device, allowing the graft to see more strain during earlier levels of graft strain until graft elongation occurs to a critical level, whereby the augment will experience more strain and protect the graft. Although long-term outcome studies are pending, animal and human clinical studies do show that ultra-high molecular weight polyethylene, when used as a suture augment for anterior cruciate ligament surgery, is unlikely to cause a significant intra-articular reaction while also providing biomechanical advantages that could prevent early graft rupture during the revascularization phase of healing.