Polypropylene Mesh Augmentation in Posterior Cruciate Ligament Reconstruction Improves Biomechanical Performance Without Additional Inflammation: A Biomechanical Study in an Animal Model

To evaluate the effect of mesh augmentation autografts in posterior cruciate ligament (PCL) reconstruction in a rabbit model in&#x2009;vivo. The left rear legs of 72 Japanese white rabbits underwent PCL reconstruction with mesh-augmented autografts (group M), autografts with mesh augmentation and suture tape augmentation (group MSA), and autografts alone (group C). The median portion of the ipsilateral Achilles tendon was used as autograft. Primary outcomes were assessed at 24&#x2009;weeks postoperatively through biomechanical testing (n&#x2009;=&#x2009;27), micro-CT evaluation (n&#x2009;=&#x2009;9), histological staining (n&#x2009;=&#x2009;9), and quantitative polymerase chain reaction analysis (n&#x2009;=&#x2009;27). Compared with autografts alone, mesh-augmented autografts and autografts with mesh and suture tape augmentation showed significantly improved biomechanical stability in terms of ultimate load-to-failure (P&#x2009;<&#x2009;.0001), elongation (P&#x2009;=&#x2009;.0004), and stiffness (P&#x2009;=&#x2009;.0003). Mesh-augmented grafts exhibited an increase in bone mineral density (P&#x2009;=&#x2009;.0487). Histological analysis showed minimal signs of inflammation within the bone tunnels of the grafts. Quantification of inflammatory biomarkers further confirmed the absence of long-term inflammation in any of the samples. Mesh-augmented grafts improved biomechanical performance in a rabbit PCL reconstruction model at 24&#x2009;weeks postoperatively without impairing tendon-bone healing or inducing sustained inflammation. PCL reconstruction with mesh augmentation, evaluated in&#x2009;vivo in a rabbit model, shows superior biomechanical properties without observed adverse reactions.