Biomechanical Superiority of the Chinese Knotting Technique in Posterior Cruciate Ligament Reconstruction: A Cadaveric Study

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OBJECTIVE: We previously developed a novel internal tension-relieving augmentation suture, the Chinese knotting technique (CKT), which demonstrated better knee kinematic recovery and clinical outcomes when assisting posterior cruciate ligament (PCL) reconstruction. This study evaluated the biomechanical effect of the CKT in cadaveric PCL reconstruction and provided experimental evidence for its clinical application. METHODS: Ten fresh-frozen adult knee joint specimens were randomly divided into the conventional reconstruction (CR; n = 5) and CKT (n = 5) groups. First, all native PCLs underwent cyclic fatigue testing with a standardized fixation method, and the relaxation length was recorded. The native PCL was then transected and reconstructed. After reconstruction, the same fixation method was applied for biomechanical testing to measure stiffness, elastic modulus, maximum load, and relaxation length. RESULTS: No statistically significant differences were observed between the two groups in donor age (54.40 ± 5.94 years vs 56.60 ± 5.98 years), gender distribution (male: 80.00% vs. 60.00%), or specimen side (left: 60.00% vs. 40.00%) (p > 0.05). All specimens underwent successful reconstruction and testing with no instances of tissue damage or fixation abnormalities. The biomechanical testing revealed no statistically significant differences in stiffness (68.60 ± 8.62 N/mm vs. 65.40 ± 12.14 N/mm) or elastic modulus (147.60 ± 5.68 MPa vs. 142.60 ± 1.52 MPa) between the two groups (p > 0.05). However, the CKT group demonstrated a significantly higher maximum load (603.20 ± 77.44 N) compared with the CR group (442.20 ± 20.52 N) and a significantly lower relaxation length (1.50 ± 0.09 mm vs. 2.46 ± 0.02 mm) (p < 0.05). CONCLUSION: The CKT preserved the basic mechanical properties of the graft in PCL reconstruction. This technique significantly increased the maximum load and reduced residual deformation after cyclic loading, thereby providing enhanced biomechanical protection for the graft. This approach may offer technical support for early postoperative rehabilitation and a reduced risk of graft failure.

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