Published on May 2, 2024
By Dr. Ravi Gupta
Recently, there is lot of debate on the use of fiber tape or internal brace in ACL reconstruction surgery. Lot of information is available on internet which is not scientifically filtered. Many patients come to me asking for, if their ACL tear should be repaired with fiber tape or internal brace. The scientific facts are as under:
The gold standard of ACL surgery is reconstruction of a torn ligament with one’s own graft. The most commonly used grafts are hamstring graft from the thigh or Bone Patellar Tendon Bone (BPTB) graft taken from the patella bone. The strength of both these grafts have been measured to be much more than a normal ACL. So these graft are widely chosen as the gold standard for the ACL surgery.
These grafts being elastic tissues expand and contract with each walking step and impart cyclic loading to the reconstructed graft. The graft tissue gets converted into an original ACL ligament in around 7-12 months time and this process is known as ligamentization. The cyclic loading due to elasticity of the graft tissue plays great role in imparting strength to the graft during the process of ligamentization.
The internal brace/ fiber tape is made from synthetic material which is chemically a polyethylene core surrounded by braided polyester and a silicone coating. This material is tied alongside the graft to provide additional strength to the graft. The fiber tape being a stiffer material does not expand and contract during the walking cycle and tends to take whole of the load of the cyclic loading with insufficient load being transmitted to the graft. Since cyclic loading of the graft is imperative to impart strength to the graft during ligamentization, the graft tied with a fiber tape is likely to take longer time for ligamentization.
Furthermore, we have operated certain revision cases of failed ACL surgery who were treated with fiber tape and observed that the broken fiber tape also causes some inflammatory reaction in the knee due to being a foreign material for the body.
Thus if there is a good graft diameter of the patient’s own body, that is supposed to be the best graft without addition of any foreign material.
However, some surgeons advocate that if due to some reasons, the graft harvested from the patient comes to be very small in diameter, then internal brace/ fiber tape may be of some benefit to protect the graft from early failure. I personally have a different opinion of this because the graft never is thin and small if one is adequately skilled for graft harvesting. But if it ever happens, I would recommend to harvest some other graft from patient’s own body like quadriceps tendon graft or peroneus longus graft rather than adding the fiber tape to the graft.
In my own practice in the last 30 years, I have operated thousands of elite players with their own graft without adding any synthetic material like internal brace/ fiber tape, who have successfully returned to their pre injury level of sports with same performance in game as of before the ACL injury.
So I reiterate that the ligamentization of an ACL graft is better and faster with one’s own graft.